Low awareness of hidden FGM/C practices

KARACHI - In certain cafés close to medical colleges in Pakistan and, of course, within the institutions themselves, students studying gynaecology speak of some unexpected sights they have seen.

“Recently, we examined a woman who complained of pain in her genital region. We were shocked to see when we examined her that she had suffered some mutilation of her private parts. I have read about these practices, but I didn’t know they took place here,” said Zeba Khan, a fourth year medical student.

Though female genital mutilation/cutting (FGM/C) takes place, the practice is hidden, hardly ever spoken of, barely known about. The country, for instance, is considered to be “free” of FGM/C, like a number of other Muslim majority countries in the region. Indeed, this view is widely held. “No such thing happens here,” said Saadia Ahmed, a gynaecologist.

But there is evidence that suggests this widely held view may be inaccurate.

“I can still remember when it happened,” said 22-year-old Zehra Ali*. She said soon after her eighth birthday, her mother “gave me a big bowl of ice-cream” and then led her to a spare bedroom where an elderly woman spoke to her kindly, had her lie down on the bed and do “a terrible” thing. Zehra says a small part of her clitoris was quickly snipped off, that she felt “some pain”, but mainly a strong sense of being “violated”. She said the episode, which she “never forgot”, causes her problems “now that I am married” and that she needed counselling before she was willing to consent to sex, “for psychological not physical reasons”.

BOHRA COMMUNITY: Zehra belongs to the Bohra community, a sect of the majority Muslim population that numbers some 100,000, according to official figures, and is based mainly in Sindh. The Bohras are among the few communities practising FGM/C in Pakistan.

Other groups that carry out the mutilation are groups with African or Arab origins, such as the ethnic Sheedi community that numbers several thousand, which came to the country originally as slaves during the 19th and 20th centuries and are based primarily in Sindh. There has been little research on the practice among these groups, though.

Zehra believes that, even today, at least 50 percent to 60 percent of Bohra women undergo circumcision, involving usually a symbolic snipping of the clitoris. “In the past, there was more mutilation, and I think 80 percent to 90 percent of women suffered it. More awareness has helped reduce the practice,” she said.
“I have seen females who have suffered ‘khatna’, as female circumcision is called. Sometimes, there is merely a symbolic snipping of some skin, but in some women, especially those who are not so young, there is somewhat more extensive cutting,” said a midwife, preferring anonymity, based in the Tando Muhammad Khan district of Sindh, who attends to Sheedi women. She said she herself did not perform circumcisions.

According to the World Health Organisation (WHO), FGM/C “includes procedures that intentionally alter or injure female genital organs for non-medical reasons”. It says an estimated 100 million to 140 million girls and women worldwide are living with FGM/C, 92 million of them in Africa.

“SYMBOLIC” CUTTING: Shershah Syed, a former president of the Society of Obstetricians and Gynaecologists who devotes his practice to serving deprived women, said he had come across cases in urban Pakistan where women have undergone the procedure.

“In Pakistan, with growing awareness [of the effects of FGM/C], they are now doing it merely symbolically, with only a bit of skin being removed. But even so, I find it to be in clear violation of human rights. There is absolutely no scientific evidence supporting any medical benefit of the procedure. In fact, it can lead to health complications,” said Syed.

WHO lists the string of complications that can arise from the procedure, including repeated infections, cysts, infertility, higher childbirth complications and the need for repeated surgeries.

“In our community, this practice has taken place for generations. The girls nowadays have it done in sterile conditions. It is rarely spoken of. It is just something the women know about and do,” said 60-year-old Raazia*, a member of the Bohra community and a grandmother. She says her granddaughters “will be safely circumcised.”

“The impact is not just on health, it is psychological, too. Such practices leave deep scars, and in our country these have not been studied at all, because so little is known about the mutilation of women in this way,” said Aliya Rizvi, a psychologist.

Zimbabwe's Circumcision drive "a waste of money"

By Business Reporter

(London)Zimbabwe is probably wasting millions from its circumcision drive which critics claim is a waste of money and is also ‘an ineffective and yet invasive attempt to prevent HIV AIDS virus infection’.

Zimbabwe’s political leaders and other advocates may actually have other motives which are not HIV-AIDS prevention critics and professionals claim.

International AIDS experts and profiteers have the financial power to force their lucrative agendas on Africa, it is claimed.

One ZimEye reader stated: “There is plenty of evidence that circumcision does nothing to fight HIV. There are more studies which show that men with foreskins are less likely to get HIV, than there are studies which show that circumcised men are less likely to get HIV. The answer is not in genital surgery. The answer is in wearing a condom.”

The comments come after the publishing of a ZimEye article on Zimbabwe’s free circumcision programs.

"Waste of money" ... Zimbabwe's Circumcision clinics criticised

One contributor named as Dr Ronald Goldman, Ph.D of the Circumcision Resource Centre in the United States, stated:

“Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. Authorities that cite the studies have other agendas. Circumcision causes physical, sexual, and psychological harm. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive.

Studies in Africa claim that adult male circumcision significantly reduces the risk of men acquiring HIV. Many professionals question the reliability and validity of these studies. However, some others take the leap of recommending adult male circumcision as an HIV prevention strategy in Africa for up to 38 million men. Publishing such a report in the United States appears to support the American cultural practice of circumcision. Such judgments are dangerous.

For American society, circumcision is a solution in search of a problem, a social custom disguised as a medical issue. Beware of culturally-biased studies on circumcision posing as science, and take your whole baby home,” states Dr Goldman who argues in detail his reasons for his dismissing f circumcision as a national program.

Traditional circumcision that removes only part of the foreskin may not protect men from HIV infection [nor may complete circumcision] , according to results of a study involving Xhosa men in Cape Town, South Africa. Almost all of the men studied had been circumcised, though some of them only partially.

South Africa has about 8 million Xhosa people, who are members of several related tribes that speak the Xhosa language, which is the second most common native language in South Africa after Zulu. Nelson Mandela and Desmond Tutu are Xhosa.

This study involved 473 young Xhosa men in Cape Town who were interviewed to determine their attitude toward circumcision [but the responses of those who said “It would be better to stop circumcision” were not counted], whether they had been circumcised, and whether they had HIV infection. Three randomized trials in Africa found that medical circumcision lowers the risk of HIV acquisition about 60% in heterosexual men.

A large majority of study participants, 92.5%, had been circumcised, though 10.5% had been only partially circumcised. Most men, 91%, had been circumcised between the ages of 17 and 22 (average 19.2).

Partially circumcised men had a 7% greater risk of being HIV positive than fully circumcised men, a significant difference (P < 0.05). HIV risk in partially circumcised men equaled that of uncircumcised men.

[ What they are glossing over is that the non-circumcised men were NOT significantly less likely to have HIV than the circumcised men: "This estimate does not reach statistical significance."]

The risk of being HIV positive rose with age of circumcision, a finding that approached statistical significance (P < 0.10). [- meaning it was not statistically significant.]

The researchers believe “efforts should be made to encourage earlier circumcisions and to work with traditional surgeons to reduce the number of partial circumcisions.”

Appeals court upholds ruling in medical lawsuit

The Iowa Court of Appeals issued an opinion Wednesday affirming the verdict in a Story County trial regarding a botched circumcision.

According to the opinion, in 2009 Olive Mwangi filed a lawsuit against Kathleen Foster-Wendel and McFarland Clinic, saying the doctor committed malpractice when circumcising her son on June 26, 2001.

Wendel apparently noted a circumferential laceration following the procedure, which was repaired with six stitches but which left excess skin.

The boy underwent a revision of the operation to remove the excess at age 7.

Mwangi later filed a lawsuit alleging that Foster-Wendel was negligent in performing the original surgery. The matter went to a jury trial on Oct. 12, 2010, with the jury ultimately finding for the defendants.

[Since there is no dotted line, there is no "wrong" way to cut part off a normal baby's healthy genitals, and hence no "right" way either.]

Mwangi appealed the decision, saying the district court should have issued a directed verdict and asked for a new trial. The district court ruled against her, saying there was conflicting expert testimony in the case.

Of the 400 males targeted, only 78 [19.5%] turned up for the exercise organised by Baylor Uganda and the Ministry of Health.

A clinical officer, Mr Ayiashi Koma, said the service targeted males aged between 15 to 55 along with free HIV counselling and testing.

“We are not impressed with the turn up because our preliminary target is high. We have only successfully operated 78 out of the estimated 400 males in the first phase,” said Mr Koma, also a trained medical male circumcision surgeon and the focal point person for safe medical circumcision.

‘Short counselling session’

Mr Koma said the exercise failed to pick up at its early stage due to shortage of funds and few trained personnel.

Mr Pastore Vulolu, who turned up for circumcision, said: “It took me time to finally accept the operation because my friends told me the wound will take four months to heal.” Meanwhile, Mr Robert Wani, who turned up for the exercise but decided not to go through with the operation, said: “I was not satisfied with the short counselling session about the importance of circumcision.”

Male circumcision is encouraged by the Ministry of Health and is recommended by the World Health Organisation in an effort to restrain the rate of HIV/Aids spread.

Dad faces jail for botched circumcision of 4-year-old

A Vancouver-area man who tried to circumcise his four-year-old son on the kitchen floor after a religious awakening could face more than a decade in jail after being convicted of aggravated assault.

WARNING: Details in this story may be disturbing to some readers.

The father, referred to as DJW in court documents to protect the identity of his son, performed the botched operation on April 2, 2007 after researching the procedure on the internet. He had circumcised himself just a few years earlier, and required stitches as well as treatment for an infected penis.

DJW was convicted in 2009 of criminal negligence causing bodily harm and sentenced to 12 months in prison, but that decision was thrown out by the B.C. Court of Appeal on Thursday. A trio of appeal court judges ruled that the would-be mohel should be convicted on the more severe charge of aggravated assault, which carries a maximum sentence of 14 years in jail, as well as assault with a weapon.

According to court documents, the father "changed his world view" after the birth of his son and began to adhere to the laws of the Old Testament. He describes his religion as "of the Abrahamic faith," similar to Judaism in some ways, but not all.

[The trial judge found "that the accused decided that because so many disasters had befallen his family, he had to 'make things right with God.'" - Huffington Post, Dec. 22, 2011]

In 2007, he decided that he needed to remove his son's foreskin in time for Passover, and consulted with two rabbis and four doctors on the procedure. The doctors told him the operation could not be done without a general anesthetic, which they could not justify for such a young child.

Frustrated, the dad tried to register in a course that trained mohels to perform circumcisions, but learned that only doctors would be allowed in.

And so, DJW decided to perform the procedure himself, resolving that he could not live in the same house with an uncircumcised boy. He told his young son that it would be "a way of unifying the family and being a family in God," according to the original court decision.

He gave the little boy a teacup full of homemade honey wine, then laid him down on top of a towel and some garbage bags and made two slices in the foreskin, using a wooden cutting board for support.

To stop the bleeding, he applied something called Wonder Dust, a powder used to treat the wounds of racehorses. The Wonder Dust label warns that it is "not for human use. For veterinary use only."

The boy's mother was at home at the time of the circumcision, but she suffers from a serious brain injury sustained during a car crash. She testified that she knew about the circumcision, but was unable to inspect her son after the procedure because she could not stand the sight of blood.

The next night, while the little boy lay in pain at home, the father travelled to Abbotsford for a traditional Passover celebration. The congregants killed a lamb, ate it and then burned the remains while they drank wine.

A few days later, a social worker arrived at the family home with police in tow after receiving a tip about the circumcision. DJW was read his Charter rights and the little boy was taken to BC Children's Hospital.

The pediatricians who examined him found his penis coated with what appeared to be hardened ash, which would not wash off and had to be removed with scissors. An experienced doctor completed the circumcision, and the boy and his older sister were removed from their family home and sent to live with their grandparents.

The boy has fully recovered from the circumcision. [A miracle! Or is he still circumcised?]

During the appeal process, the father contested his criminal negligence conviction, but that bid was denied on Thursday. He has yet to be sentences on the aggravated assault conviction.

[Under California law and a pending Federal law, this would be legal.]

'Circumcision: Canal for new HIV infections'

HARARE - Male circumcision is becoming a canal for new HIV infections as men are now reluctant to use condoms on the basis that they are 60 percent safe, a government official has said.

MDC deputy spokesman and legislator for Bulawayo East Thabitha Khumalo said while circumcision was good in reducing the risk of HIV infections in men, the emphasis should be on the use of condoms than [sic] circumcision in order to save both men and women.

Circumcision and the use of condoms, Khumalo said, should be used together if Zimbabwe’s goal of Zero to new HIV infections and Zero to HIV related deaths by 2015 is to be attainable.

“We have a huge challenge where male circumcision has created a canal to those who do not want to use condoms.

People should understand that circumcision is not a cure, it is just a way to help reduce the risk of infections, together with the use of condoms, said Khumalo.

Khumalo said women will be the most affected because they have limited methods of protecting themselves.

According to Khumalo, Sub-Sahara Africa still records the highest figures of new infections with about 7 000 estimated infections despite the increase in the numbers of men who are getting circumcised.

More than 40 000 Zimbabwean adult men, according to reports, have been circumcised since the programme began in 2010 and 100 000 more are expected to undergo circumcision by the end of 2012.

Zimbabwe has set a goal of circumcising 1,2 million men by 2015.

Sinokuthemba Xaba, Zimbabwe’s national male circumcision co-ordinator told the state media that approximately 11 000 men were circumcised by December 2010, with over 20 000 having been circumcised this year alone.

He said preparations were under way for the launch of a neo-natal circumcision programme, where the medical procedure will be performed free of charge on male babies as soon as they are born. [Yet babies do not have sex.]

In August, government started an ambitious programme aimed at male cabinet ministers, MPs and councilors to undergo circumcision.

Deputy Prime Minister Thokozani Khupe said research had shown that circumcised men are eight times less likely to contract HIV.

Health department's message on circumcision

The Eastern Cape health department appealed on Thursday to initiation schools to ensure smooth running of the custom.

This comes after hospitals in Mthatha were inundated with young men injured from botched circumcisions.

“The All Saints hospital in Engcobo is flooded with injured initiates,” said spokesman, Sizwe Kupelo.

“They now have a total of 33 initiates and the wards are full and cannot admit anymore. They are trying to arrange referrals with neighbouring hospitals because it is also affecting their day-to-day operations,” said Kupelo.

“There are young men who are requiring treatment for septic wounds and gangrene, which points to the mismanagement of their wounds at the initiation schools. We are calling to stakeholders in traditional circumcision to ensure smooth running of the custom,” said Kupelo.

He further said that All Saints was not the only hospital in Mthatha facing the problem.

“There is no place for them at the hospital and that illustrates how bad it is in that area. The Mthatha General Hospital and the Nelson Mandela Academic Hospital are feeling the same pressure,” Kupelo said. - Sapa

German scientists grow artificial skin using cells from babies' foreskins

The scientists hope to provide a humane alternative to animal testing

By Braden Goyette

German scientists have created a machine that manufactures human skin using cells from a baby boy’s foreskin.

The scientists at the Fraunhofer Institute hope the skin they’ve been able to produce will provide a humane alternative to using animals in testing of cosmetics and other products, a German news service, the Deutsche Presse Agentur, reported.

The machine has been dubbed the “Skin Factory.” It is about 22 feet long, 10 feet tall and 10 feet wide. It fosters the growth of skin samples from cells extracted from foreskins of boys 4 years-old or younger who are circumcised.

Before a child’s foreskin was contributed to the project, their parents provided the scientists with permission, according to Germany’s Suedkurier newspaper. [But he didn't.]

Foreskins were not used by the scientists merely because they were a source of excess human skin cells. [because they're not excess - to him.]

“It's also important that the cells come from as uniform a source as possible, in order to avoid abnormalities in the production of new skin.”

[How about using umbilical cord tissue?]

The scientists are also looking into using stem cells as a source for skin production.

After the cells from the foreskins have multiplied inside the machine, they’re injected into a gel that forces them to grow into a sheet that simulates the epidermis — the outermost layer of human skin. To create a model that simulates human skin, three of these layers are fused together, according to the Suedkurier.

The process of growing new skin takes about six weeks. At present, the Fraunhofer Institute is producing about 5,000 new samples per month, the DPA reported.

For their next project, the scientists are working on reproducing the human cornea.

Prosecutor calls for suspended sentences for parents and man who performed religious circumcisions

Twelve-year-old boy missed month of school because of ill effects of botched procedure

Prosecutors are calling for suspended prison sentences for the parents of two Helsinki families who had their school-aged sons undergo religious-based circumcisions in 2009 and 2010.
The man who performed the procedure was charged with two counts of aggravated assault and battery.
The parents are on trial at Helsinki District Court on charges of incitement to commit aggravated assault and battery. All defendants pleaded innocent.

The boys, both Muslims, were seven and 12 years old respectively when the procedures took place.
The parents had asked if the circumcisions could be performed as part of public health care. After getting a negative response, they found a person who said he could do the procedure.

The Finnish Supreme Court has given a ruling on non-medical circumcisions in Finland. The court ruled in one case that religiously mandated circumcisions are not a crime in Finland if they are performed by a competent medical professional.
The prosecution and the defence in the present case took two different views of the implications of the Supreme Court’s ruling. The prosecutor feels that only licensed doctors should perform circumcisions.
The court is to give its decision in the matter next week.

Mob attacks three over male 'cut'

By Joseph Lyimo

Babati. Three people, including a Moravian Church pastor and a police officer, were seriously injured in Babati District in a series of attacks by conservative Maasai traditionalists in Manyara Region for failure to abide by traditional way of circumcision.

Such harassment and beating of church leaders accused of disobeying the traditional male circumcision started in Arumeru District a fortnight ago.

Pastor Noah Mollel and a church official, Mr John Noel, were last week roughed up by Maasai men armed with traditional weapons for allegedly defying their customs by taking their children to the hospitals for circumcision.

They have been admitted at the Babati Hospital nursing injuries they sustained during the attack carried out by over 100 Maasai men.

A police officer, Mr John Najulwa, who rushed to the scene on a motorycle to calm the fracas, was not spared either. He was hit on the head and has been admitted at the hospital with serious head injuries.

The doctor in charge at Mrara Hospital, Dr Vincent Mayalla, said the trio sustained several injuries and cuts on their bodies but they were out of danger.

The yet another embarrassing incident took place at Ng'anyi hamlet, Ayamango Village at Galapo Division, some 30 kilometres south east of Babati. The Manyara regional crimes officer, Mr Benedict Msuya, said police are investigating the incident.

Reports from the area say the victims of the 'mob justice' were paraded half naked covered with nylon bags and taken around the villages.

Conservative Maasai traditionalists as well as other tribes in the northern regions, consider circumcision of men in hospitals rather than by locally approved traditional surgeons, as an insult to their tribe and norms.

"We were forced to walk almost naked through the village while being beaten," Pastor Mollel and Mr Noel told The Citizen. They said despite being members of the Maasai tribe, they were against such humiliation.

No legislation in Finland yet on religious-based child circumcision

Two criminal cases go to trial

The three-week old son of a Jewish family in Helsinki was circumcised at the age of eight days.
Although tradition calls for holding the ceremony among men, the mother decided to hold her son's hand during the procedure.
"I don't think that I would have agreed to the operation without a local anaesthetic", the mother says.

Holding a ritual circumcision, or bris was virtually a foregone conclusion for the family. The procedure was performed by a Finnish surgeon.
"I didn't want to invite my non-Jewish friends to the name-giving ceremony, because the atmosphere in Finland is such that I don't really know who to tell about these things."
Many other parents, for whom circumcision is part of the family's religion or culture, think the same. Some who have had their sons circumcised in recent years have been charged with assault and battery.

Helsinki District Court is hearing two cases on Monday in which parents and a person performing a circumcision are accused of assault and battery. The person performing the circumcision did not have medical training in Finland.
District Prosecutor Eija Velitski, who brought forward the charges, feels that it is problematic that there is no law in Finland that would define the terms under which non-medical circumcisions can be considered acceptable.
In the case at hand, prosecutors and police are leaning on the criminal code in which the infliction of bodily violence with a sharp object is considered aggravated assault and battery.

There is one precedent dating back to 2008.
In it, the Finnish Supreme Court found that the circumcision of a Muslim boy was not a crime, as it was performed in a medically appropriate manner for acceptable, religion-based reasons. The Supreme Court has not yet ruled on a case in which the procedure was performed by someone other than a doctor.
At the appeals court level, there have been both convictions and acquittals for having circumcisions performed by a layperson.

In the view of Raimo Lahti, Professor of Criminal Law at the University of Helsinki, the situation is legally vague, and the decision of the Supreme Court does not adequately address the issue. There are no clear guidelines on who is authorised to perform the surgeries, and what the attitude of the health care profession should be.
Lahti feels that the matter should be evaluated against the backdrop of the Council of Europe's Convention on Human rights and Biomedicine.
According to the treaty, a procedure affecting a person's health can only be performed on a person incapable of giving consent, if there is an immediate benefit for the person in question.

Debate on the need for legislation has been going on for more than a decade, and in 2003 the Ministry for Social Affairs and Health proposed legislation that would allow circumcisions to be performed under certain conditions.
The proposal got a mixed reception, and preparation of the law was not continued. ...

King calls for halt in initiate deaths

By Sithandiwe Velaphi

Eastern Cape
Xhosa King Mpendulo Zwelonke Sigcawu has appealed to traditional leaders to work together with their respective municipal councillors in a bid to curb the “unnecessary” deaths of initiates during the December holidays.

The king said it was the duty of traditional leaders to show leadership when there was something amiss in their territories.

“To me it is not a good thing to read about the deaths of initiates, hence I am saying that traditional leaders must show their leadership in this important custom of our forefathers,” said Sigcawu.

Two initiates were reported dead in Matatiele and Bizana earlier this month.

The latest umkhwetha (initiate) to die was from Holela village, Centane, last Thursday.

Police spokesperson Capt Jackson Manatha said: “It is alleged that the deceased was from a nearby village.

“Elderly men observed that he was ill and weak. A car was organised to take him to Butterworth hospital but he died on the way. An inquest docket has been opened.”

Sigcawu urged traditional leaders, as custodians of tribal customs, to be at the forefront of stopping the death of initiates.

The provincial government earlier this year set aside R14.3m for efforts to stop the death of initiates.

A total of 25 initiates in the province died in June from genital amputations while 21 died in December last year.

MEC for local government and traditional affairs Mlibo Qoboshiyane in July said: “It was shocking to learn of the increasing commercialisation of traditional circumcision in some communities, with one ingcibi (traditional surgeon) charging R1600 to circumcise one boy.

“In this case, he had at least 61 initiates in his schools,” said Qoboshiyane.

MPs summon Puntland Ministers on FGM motion

GAROWE, Somalia Dec 13 2011 (Garowe Online) - Some Members of Parliament agreed to summon four ministers in Puntland State of Somalia due to a motion that has been regarded controversial that banned Female Genital Mutilation (FGM) in Puntland, Radio Garowe reports.

Puntland MPs met in the capital Garowe today to discuss summoning four Puntland Ministers that they felt broke certain religious rights of Muslims when they had passed a motion to ban FGM in Puntland.

The four Ministers included the Minister for Women's Development Asho Gelle, Minister for Education Abdi Farah Juha, Minister for Ports Said Mohamed Rage, and State Minister for Planning and International Cooperation Abdulkadir Hashi.

The Puntland Parliament summoned the four ministers because the motion to ban FGM in Puntland also bans Sunni circumcision for women, which is a common practice in Somalia and other Muslim countries. Sunni circumcision of women is not an obligation, while FGM is anti-Islamic, according to scholars.

[So sunni circumcision is not an obligation of Islam, just something they like to do?]

The World Health Organization (WHO) defines FGM as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons."

[And this excludes sunni circumcision how?]

The ant-FGM motion, which has been supported by senior Puntland officials, is expected to be passed by the Puntland Parliament after removing the clause that violates Sunni circumcision, according to parliament sources.

Puntland is located in northeastern Somalia and has had its own functioning government since 1998.

Stop harassment, clerics urge govt

By Zephania Ubwani

Arusha. Church leaders have criticised traditionalists for harassing those opposed to their way of behaving or doing things.Traditionalists have been accused of beating up men who refused to follow traditional initiation rites.

They have called on the government to intervene urgently and save innocent people from being beaten up, intimidated and sometimes paraded naked allegedly for not abiding by traditional ways of circumcision.

"Beating somebody and stripping him naked in public is not only a blatant violation of human rights but is also against the law," their leader to the deputy minister for Lands, Housing and Human Settlements Development Goodluck ole Medeye, who is also the Arumeru West MP, noted....

... groups of diehard traditionalists among Waarusha and Maasai tribes ... are waging a campaign of terror against those perceived not cooperative in recent days.

The violent bands target fathers or guardians whose boys are circumcised in hospitals. Fathers whose boys are “cut” by circumcisers not recognised by community elders also incur the wrath of the conservatives. The church leaders are worried about the situation taking into account the fact that Mr Medeye “inaugurated” the community-wide circumcision in Arumeru District a few months ago.

... some elders, including a pastor, have been beaten up and paraded naked. Others had their livestock confiscated or threatened with banishment.

They cited what happened on November 5 to Mr ... after his boys were circumcised at Olevolos Village when the elderly man was confronted by people who stripped him naked, thoroughly beat and took him around the area while naked. Later on the same group returned and took his cow by force and slaughtered it. On November 12, Mr ... , Mr ... , Mr ... and one identified only as Mr ... , all elders of Shiboro and Ilkiding'a villages, had their cattle, sheep and money taken away.

On November 17, Mr ... of Siwandet Village was stripped naked. He was later covered with a nylon bag and taken around the hamlets while being flogged and booed. Police rescued him the following day. His wife suffered a similar fate.

A few days later, it was reported that a church leader in the area was hauled from his home and stripped naked and taken around his village. His colleagues escape. The treatment forced church elders in some villages to flee their homes for sometime.

Similar incidents have also been reported at Timbolo, Sambasha, Olosiva and Marurani villages and elders said to have lost their animals or subjected to beatings.

PNG circumcision research uncovers horror penile modification trend

Research in Papua New Guinea on circumcision as a means of prevention of HIV transmission has brought to light the number of men undergoing unsafe penile modification, often with disastrous consequences.

Professor John McBride of Australia’s James Cook University was one of a number of researchers presenting their work to the PNG government and non-governmental organisations in a recent two-day policy forum in Port Moresby.

He says most men are amenable to being circumcised, with almost 60 percent having had either full or partial circumcision, known in PNG as the straight cut.

Professor McBride says all the research groups were concerned about the potential adverse effects of that informal type of circumcision and other forms of penile cutting.

“One of the recommendations to come out of the policy forum was to look at how we can reduce the harm that’s associated with informal circumcision and other circumcision practices such as injecting oils and other substances into the shaft of the penis as well as inserting foreign objects under the skin of the penis.”

[While the elephant in the room is the horror and harm of "formal" circumcision....]

Villagers ignore the law and go on a girl circumcision frenzy

The sound of gun shots pierced the air as seemingly intoxicated youth joined girls and women in wild celebration.

Tradition had triumphed over law as hundreds of girls, some as young as eight years old faced the knife in a procedure that is internationally loathed and outlawed — female genital mutilation.

The setting is Kuria East and West districts. It’s is the third year since the last rite, and so a fresh set of girls are supposed to undergo the FGM among the Bugambe and the Buiregi clans.

Tuesday was the culmination of three days of activities that saw the villagers throng footpaths in wild celebration, armed with home made guns, machetes, spears, knives, clubs and other weapons that would ordinarily have their wielders jailed.

Hundreds of schoolgirls underwent the traditional rite of passage that now allows them to get married, raising doubts as to whether they will continue with their studies in the New Year.

Among the health concerns associated with the practice are complications during childbirth, heavy bleeding after birth and prolonged hospitalisation, with the degree of complications increasing depending on the extent and severity of the mutilation that can also cause infections and death.

The killer virus, HIV, is also readily transmitted this way.

Teachers in the area said that while the practice had been part of culture, it lead to significant deterioration in the standard of education as girls dropped out of school soon afterwards.

Mr Mosese Chahacha, a teacher in a local primary school said: “The rituals the initiates go through before the material day is like parallel education.

“They learn that they are adults and that they can stand up to anybody besides starting a home. It is very difficult for the teachers to discipline such children.”

“The government allowed us to circumcise the men, which we did, but then we later wondered: now that we have taken men through the initiation, must we not create a pool of women from where they can marry? That is why we have decided to undertake the practice,” argued Mr Kohe.

Early in the week, two women circumcisers were arrested by police while “cutting” five young girls. The law enforcers laid a trap near the circumcisers’ homes and nabbed them soon after they began the “surgery”.

But the locals, who are predominantly members of the Kuria community, blocked the police vehicle, demanding immediate and unconditional release of the women.

December 7, 2011

New review slams RCTs

By the Intactivism Pages

A new review of three Randomised Controlled Trials (RCT) of circumcision in Africa slams the claim that they prove that circumcision reduces the chances of men contracting HIV/AIDS.

The review, in the Australian Journal of Law and Medicine, is by independent research consultant, Professor Gregory J Boyle of Queensland, and George Hill, the Vice-President for Bioethics and Medical Science of Seattle-based Doctors Opposing Circumcision.

The review also looks at a related survey, in Uganda, of the effect of circumcising HIV-positive men on transmission of the virus to their female partners.

Boyle and Hill find several problems with the methodology of the three trials, that jeopardise their internal validity

researcher expectation bias;

participant expectation bias;

inadequate double blinding;

lead-time bias;

selection and sampling bias;

experimental mortality; and

early termination.

To measure researcher expectation bias, they analysed the references the researchers used and found significantly more pro-circumcision and fewer anti-circumcision references than are available in the HIV literature.

Boyle and Hill point out that the early termination of all three trials would have amplified the protective effect of "lead-time bias" (delay by circumcised men in resuming sex). In at least four cases in the Kenyan trial, men apparently contracted HIV through circumcision.

"Since some men acquired HIV without reporting unprotected sexual exposures, the RCT authors had a duty of care to investigate such non-sexual transmission," they say. "Researchers controlled the information available to men so that provision of fully informed consent
may have been compromised."

"Why was there such a brief 'cooling off' period for men allocated to the male circumcision group?" they ask. "The surgery was carried out almost immediately after randomisation, ensuring that participants had little time to change their minds."

Boyle and Hill have ethical concerns about the male-to-female trial, in that the women were not informed that their partners were HIV-positive so that they could protect themselves.

They conclude: "Male circumcision is a dangerous distraction and waste of scarce resources that should be used for known preventive measures."

Uganda: Mad Rush for Medical Male Circumcision

By Asuman Musobya and Sam Caleb Opio

Bugiri/ Kamuli — A total of 2,450 men have been circumcised in Bugiri District since the government Safe Male Circumcision programme started early this year as a measure to address the spread of HIV/Aids.

The District Health Officer, Dr Stephen Kirya, disclosed the figure during celebrations to mark the World Aids Day at Ndifakulya Primary School last week. The majority of those circumcised are youths between 20 to 30 years, he added.

Dr Kirya said medical personnel anticipate more people will come for the exercise during this holiday season. He attributed the massive turn-up to increased sensitisation by health officials about the benefits of the programme, adding that all newborn baby boys in government hospitals in the district are to be circumcised.

[What? All? Without even their parent's consent? Babies don't have sex, and there is no evidence whatsoever that neonatal circumcision has any effect on HIV.]

Meanwhile, in Kamuli 60 men were circumcised at Kakindu, bringing to 512 the number of circumcisions in the district this month. The project coordinator, Mr George Luyiro, promised outreaches and advised those circumcised not to be excited into reckless sex.

Bennett circumcised

Outspoken Mbabane-based businessman Walter Bennett on Friday suggested that government should make circumcision a prerequisite for all males seeking scholarships and jobs in the public sector.

He said circumcision is so important that people must be reminded in all corners that they should do it.

“It takes only 20 minutes to get circumcised, so what is the excuse of not doing it? Circumcision is a simple medical procedure that only complacent and laid back Swazis can resist.”

Admitting that he is also circumcised, Bennett said Swazis should take advantage of the male circumcision programme not only because of its ripple benefits in preventing HIV and STIs but because it comes free of charge, courtesy of donors, especially the American Government.

“Let us all start to behave responsibly and be sexually disciplined (SD). ...

Bennett was speaking at the Mbabane Government Hospital at the launch of an HIV and AIDS campaign and a VCT testing centre at the then hospital’s Out Patient Department (OPD).

Aid cut to affect one million HIV positive Ugandans

By Joyce Nyakato

MORE than one million people will be directly affected by the decision of Global Fund to cancel the round 11. The unexpected decision was taken by the Global Fund board of directors on Tuesday. The money was meant for 2014 - 2016.

Government and Ministry of Health officials were still discussing the way forward and many were tight-lipped about the alternative source of funding for the national response planned for fighting HIV, Tuberculosis and malaria.

Government was planning to launch a National HIV/AIDS strategic plan, aimed at reducing the number of new HIV infections by about 30 per cent in the next five years. It includes plans to treat all people living with HIV who need treatment.

Government was also planning to give free ARVs to 50 per cent of people whose partners have HIV, all infected children and all pregnant mothers, regardless of their CD4 count.

Also in the plan was to roll out free medical male circumcision to at least two million men, accredit more health centre IIIs to provide ARVs, which would add 150 centres more and adopt an open policy to provide ARVs to HIV negative people who think they are at risk, especially those who are married to reckless partners.

However, according to Dr Fred Magara, the programme co-ordinator at Walter Reed project, says it is not clear whether people currently receiving ARVs will be affected.

“After the scandal of 2005, donors started sending ARVs and not cash. The suspension of funds will affect other activities and maybe the scaling up,” he said.

Asia Rusell of the Health Global Access Project explains that the Uganda budget for Global Fund round 11 included the continuation of HIV programmes and scaling up interventions.

“The main risk is how to get alternative funding because the whole response is at risk,” she says. “We now must push for more Government contribution because the human costs of scaling back lifesaving programs in Uganda would be unthinkable.”

The Yin, Wounded

Dawoodi Bohra Muslims are Ismaili Shias and trace their origins to the region in and around Egypt, from where they might have adopted the practice besides other local customs. Now intrinsic to their identity.

Most of the community lives in Maharashtra, Gujarat and Rajasthan. Population: 10 lakh [1 million]. Are prosperous traders and well educated.

Most Bohras are under the control of the clergy, headed by the Syedna. Those who question the clergy’s authority find themselves excommunicated.

Bohra girls undergo genital mutilation when they are seven years old. It is a clandestine ritual unlike male circumcision that is publicly celebrated. No other Muslim sect in India observes this ritual.

The hood of the clitoris is cut off. This is followed by application of an antiseptic and an indigenous medicine called abeer that cools.

The crude mutilation of the clitoris exposes the nerve endings and is meant to discourage
masturbation and limit possibility of sexual pleasure from clitoral stimulation

The procedure is called khatna, it is carried out by select elderly women of the community and often without medical supervision, using just a razor

Little details are available of the extent of this practice, given the secrecy. There are claims, though, that some choose to go to hospitals to get it done.

Justified in the name of community traditions and religious sanction. Critics, however, say there is no mention of it in the Quran.

Online forums like Rage of Bohri Women are encouraging women of the community to speak up.

It has been 53 years since she was subjected to the agony. But as Zenab Bano, a retired political science professor in Udaipur, recounts the horror of that day, the wound is laid bare all over again—still raw, still unhealed. Barely seven years old then, she was told to go with her friend and her grandmother to a function for children at the end of which she would get a gift. “Before I realised what was happening, there was this woman pulling down my undergarment,” she says. “I had no idea what she was doing. It hurt a lot and I cried.” What Bano describes is the female circumcision ritual called khatna that most Bohra Muslim girls in India had to go through then. And which is still a rite of passage for many even today.

What happened to Bano was never openly talked about within her household. “Whenever I asked my mother about it, she would say it’s nothing and that it’s done to all,” she says. The efforts of a 42-year-old Bohra woman from Mumbai, however, may finally bring the taboo subject to light, despite the cold indifference of orthodox members. Tasleem (who doesn’t want to reveal her surname), the mother of a 19-year-old girl, launched an online petition this October to try and get Bohra high priest Mohammed Burhanuddin to put an end to this archaic ritual. She sent her campaign material, including a large cardboard blade embossed with a photograph of a wailing girl being circumcised, to Burhanuddin’s office, but got no response. This campaign has now been picked up by Indian Muslim Observer, a website dedicated to Muslim affairs, for broader dissemination amongst other Muslims. According to Tasleem, khatna is still widely practised. “It still happens among rich, poor, the middle class,” she says. “I’d say 90 per cent still practise it.” Bohra reformist and scholar Asghar Ali Engineer too acknowledges that female circumcision is still very much prevalent. “But it would be difficult to ascertain the scale as it is a very hush-hush affair. In big cities like Bombay, it is done is hospitals right after birth and in smaller towns it is done around the age of six.”

Khatna is a tradition the Bohras trace back to their origins in Africa, one they continue with because they see this as an attempt to stay true to their faith. However, most Bohra women and men even today would rather keep this practice a secret rather than question a custom that is now universally seen as a gross violation of a woman’s body.

“There has to be zero tolerance for something downright degrading like this,” says Tasleem. “One can argue that there are certain health benefits to male circumcision, but for women there is nothing but pain. In fact, it’s pure gender bias because it’s meant to suppress a girl’s sexual desire (see info box). You don’t really castrate a man, do you? He can go on raping, that’s fine, but a woman must be under control.”

Tasleem herself was lucky to have had parents who spared her the pain and indignity, something her daughter can also thank Tasleem for. Very few Bohras have signed up so far for Tasleem’s campaign; most who have are non-Bohra Muslims and Hindus. It is an uphill task, for it’s not just conservative women who force circumcision on their daughters but, in at least one instance according to Tasleem, even a liberal woman based in Dubai, who even as she sends her daughter to an international school chose to bring her to Mumbai to be circumcised.

When contacted by Outlook, Quresh Ragib, who handles public relations at the high priest’s office, flatly refused to discuss Tasleem’s petition. “I am not interested in discussing this non-issue. The real reason behind this petition is propaganda. They are just using you like tissue paper,” he said.

But even as some within the community may find the ritual abhorrent, they continue to perpetuate khatna because it guarantees support from the Bohra clergy and members. As one Bohra father put it to Outlook, many parents who choose not to circumcise their girls fear being excommunicated from a community that is closely knit under the influence of its clergy, which supports the practice but doesn’t enforce it directly. Not following traditions, like female circumcision, can also preclude important milestones in the life of a Bohra girl, like misaaq (initiation ceremony into adulthood) and exclusion even after death by not being allowed burial at a communal graveyard. “Who wants to take up a fight with the community?” he asks. “We just lie each time somebody asks us if we have got our two daughters circumcised.”

There seems to be no religious sanction for khatna. “It has nothing to do with Islam,” says Asghar Ali Engineer, “as the Quran doesn’t mention it. There may be some controversy about its mention in the Hadith but the fact is that it is an attempt to suppress sexuality so that women do not go astray.” One invalidated theory supports the idea that the Bohras, who are essentially a trading community and would travel often on long voyages, adopted this practice to prevent their women from having extra-marital affairs in their absence. Another prominent Bohra Muslim and a noted social activist, J.S. Bandukwala, tells Outlook that the practice stopped in his family with his mother. “The family felt it was not needed at all. It’s not mentioned in the Quran and even leads to unhealthy consequences.”

Indeed, more than just an abuse of women’s rights, khatna can also cause medical complications if executed in unhygienic conditions or by an untrained pair of hands wielding the blade. Bano, who is researching abuse of women in south Rajasthan for a project sanctioned by the University Grants Commission, is documenting actual instances where female circumcision did go horribly wrong. This includes a case where a Bohra girl had to be hospitalised in Udaipur a few years back because she had bled excessively after suffering a cut deeper than what was intended. It reminded Bano of the time her childhood friend went through the same trauma.

Because it still tends to get done secretly, even Bano has little idea if conditions have improved at all. “One does not really know if the dais use the same kind of razor blade as in my time, if the blade is new or is it sterilised,” she says. In a paper titled ‘All for Izzat’ that she wrote in 1991, Rehana Ghadially, a retired professor from IIT-Bombay and who suffered the indignity herself, profiled a 75-year-old woman who used a “rusted barber’s razor duly blessed by the clergy” and a small stone to sharpen her razor. But even if it is medically supervised and hygienic these days, it doesn’t make the rationale for female circumcision any more acceptable.

The practice finds mention in a 2009 cable on the Bohra community from the US consulate in Mumbai. Detailing an interaction between six Bohra women and consulate representatives, the women reportedly “affirmed that female circumcision was practised in their community, ordained and supported by the Syedna’s decrees”. Terming the practice “medieval”, the cable (among those made public by Wikileaks) adds that they “acknowledged that for males, the circumcision is for health reasons and that for women the procedure is to curb sexual desire and prevent wives from straying from their husbands”. Neelam Gorhe, a women’s rights advocate and member of the Maharashtra legislative council, is cited in the cable as someone who has come across such cases.

When contacted, Gorhe, also a gynaecologist, did affirm she knew women from “certain western states and a certain section of the society whose clitorises—and not just their tips—had been completely removed.” According to her, the first step in trying to deal with this practice is to acknowledge that it actually happens. “Rather than ban this with force, this has to go along with social transformation and be carried out in a manner that’s participatory and democratic,” she says. Tasleem’s petition, whether successful or not at this stage, may just provide the chance to begin a conversation on the subject.

November 23, 2011

South African doctor warns against using circumcision to fight HIV

Johannesburg - The editor of the South African Medical Journal warned on Wednesday against a government plan to promote circumcision as part of an anti-HIV campaign, saying it may end up undermining gains made in encouraging condom use.

'I'm proposing that South Africa stop the roll out until this new fad has been more thoroughly investigated,' Daniel Ncayiyana, the editor of the peer-reviewed medical magazine told City Press newspaper.

The remarks came ahead of World AIDS Day on December 1. Some 34 million people globally are believed to be living with HIV, but the UN has noted a decline in the number of new infections this year.

In South Africa, the country with the largest number of people infected with HIV, the health department has begun to promote circumcision as part of its campaign to encourage safe sex.

The department says it only offers the minor surgery after men have been informed that circumcision is not a 'silver bullet' and that it can only help reduce, but not eliminate, female-to-male infections of the virus that causes AIDS.

Neighbouring Zimbabwe has also embarked on a massive country-wide campaign to circumcise men and help stop the spread of the virus.

Zimbabwe 2005-6

HIV Rates:

Circumcised men

20%

Intact men

19%

November 23, 2011

Chiefs oppose infant 'snip'

By Mawande Jack

The national medical circumcision plan to circumcise all male babies immediately after birth and in hospitals has been rejected by Eastern Cape traditional leaders.

The outright rejection of the hospital circumcision plan as introduced by Health Minister Aaron Motsoaledi came while the AmaXhosa, AmaMpondo and other ethnic groups in the province were bracing themselves to send thousands of boys to the mountain to be initiated to manhood during the coming festive season. This includes the December holidays and provides an opportunity for school boys who have reached the age of manhood to undergo the circumcision ritual before they graduate to manhood.

During the official opening of the ulwaluko (initiation) season, Eastern Cape House of Traditional Leaders chairman chief Ngangomhlaba Matanzima criticised Motsoaledi for introducing the hospital plan and especially for infants. “It is wrong to ask boys to go to a hospital and to perform a medical circumcision,” he said. Matanzima, who also boasted of having undergone initiation, said people who went to hospital were those who were sick. “These boys are not sick. Why must they go there?”

About 50000 young boys across the Eastern Cape are expected to go to the bush to undergo the Xhosa rite of passage where circumcision is used to teach the boys morals and values of manhood based on centuries-old traditions and custom. The custom is also believe to instil respect in the young men.

The Ministry of Health said it intended circumcising about 5.7 million baby boys over the next five years to prevent HIV and other sexually transmitted diseases. Last year the Health Department’s circumcision plan saw 100,000 boys circumcised in hospitals in all the provinces.

[There is no evidence that circumcising babies has any effect on HIV.]

Kenyan girls cross into Tanzania to escape mutilation

Hundreds of girls are believed to have crossed over to neighbouring Tanzania for fear of being forced to undergo female genital mutilation.

According to residents in Kuria, hundreds of girls, some as young as ten years old, have fled their homes to avoid the traditional rite which is scheduled for December among the Abagumbe clan.

The girls are reported to have escaped within a period of one week to avoid forced female circumcision commonly referred to as female genital mutilation (FGM).

Mr John Gichoro, a resident of Nyabohanse village, said that preparations for the cultural celebrations were already ongoing even as the Government issued a stern warning that it would arrest and prosecute any parent or guardian subjecting children to the backward practice.

Speaking in the area, Nyanza PC Mr Francis Mutie who toured the region last week described the rite as retrogressive and asked the community’s leaders to find alternative ways of ushering their children to adulthood.

"This is something that has to change as it denies our girls a chance to lead a normal life," he said adding that researchers have confirmed the practice has no benefit to the girls or the community.

There have been reports of some parents believed to be faking their daughters’ disappearance to enable them circumcise them secretly in their homes.

A number of organsiations fighting the vice in the region have been urged to establish secluded camps where girls would be trained on alternative rites of passage.

Kuria west district children’s officer John Langat said his office in collaboration with a number of NGOs the police, the provincial administration and churches, had taken the necessary measures to protect girls from being forced to face the knife.

"We are aware of those planning to launch this rite within the abagumbe clan but we are not going to allow them infringe the rights of their daughters this time round," Mr Langat warned.

The Kuria community has four clans, which practice the outlawed rite of passage in liaison with their kin in Tanzania.

Male circumcision leads to a bad sex life

Circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life, a new study shows.

By Niels Ebdrup

If a man is circumcised, he faces an increased risk of experiencing delayed orgasm, and his female partner has an increased risk of not feeling sexually fulfilled.

This is the clear-cut conclusion of a new Danish research article, which has received international attention.

Some 5,000 sexually active men and women were surveyed about their experiences and possible problems with their sex lives. With a specific focus on circumcised men and their women, the results are startling.

“Circumcised men are three times as likely to experience a frequent inability to reach an orgasm,” says one of the researchers, associate professor Morten Frisch of SSI, a Danish research, production and service enterprise.
Research into the effects on women is unique.

This is one of only a few studies of the sexual consequences of male circumcision, and in one area in particular it is groundbreaking:

“Previous studies into male circumcision have looked at the effects it has on the men. But scientists have never really studied the effects this has on the women's sex lives,” says Frisch.

“It appears that women with circumcised men are twice as likely to be sexually frustrated. They experience a three-fold risk of frequent difficulties in achieving orgasm, and an eight-fold risk of feeling pain during intercourse – also known as dyspareunia.”

Circumcised men prefer it rough
There appears to be a very simple reason why circumcised men and their partners are having problems with their sex lives.

The circumcised man develops a thin layer of hard skin on his penis head, which decreases the sensitivity. This means that in order to reach an orgasm, he needs to work harder at it, and that can lead to a painful experience for the woman.

“We conducted a survey, but the data does not explain why these problems occur. There are, however, some good suggestions in the scientific literature,” he explains.

When the penis enters the vagina, the foreskin is pulled back. And on its way out again, the foreskin goes back to cover the penis head. This way the foreskin stimulates both the man and the woman.

The gliding in-and-out movement of the foreskin, combined with the in-and-out movement inside the vagina, constitutes what is known as ‘the gliding movement’.

“When a circumcised man moves in and out of a woman without 'the gliding movement' caused by the foreskin, it can have a painful effect on the woman's mucous membrane. This could explain the pain and the tendency towards dryness that some women with circumcised men experience.”

Sources of error were filtered out

A vast majority of the circumcised men in the study were circumcised based on a doctor's estimate.

Facts:

In the U.S. some 50 percent of all boys are circumcised.

Circumcision is – or rather has been – common in many English-speaking countries. This is due to a trend from the Victorian age where doctors recommended that boys should be circumcised as this would make it more difficult to masturbate.

At the time, masturbation was thought to lead to a long list of problems, including mental illness and typhus.

“Only five percent of all Danish men are circumcised, yet we have statistically valid evidence that male circumcision can be associated with sexual problems.

The study did not involve many religiously circumcised men – Jews and Muslims, for example. But even with these factors taken into account, the data pointed in the same direction. The statistical analyses also took a long list of additional relevant factors into account, including:

Age

Cultural background

Religious background

Marital status

Levels of education

Household income

Age at first intercourse

Number of sex partners

Frequency of sexual activity with one partner in the past year

“We adjusted for all these factors in an attempt to ensure that circumcision is the actual cause, and that the link isn’t attributable to other factors.”

Bottom-line results were clear
Frisch mentions an example of how things get muddled up if researchers do not adjust for possible sources of error when they work with statistics:

“If, for instance, you look at people who drink lots of beer, you'll see that they face an increased risk of developing lung cancer, compared to those who don't drink much,” he says. “But it's not the drinking itself that causes the lung cancer. There just happens to be a correlation between drinking and smoking, and it is actually the smoking that causes the lung cancer.”

These kinds of error sources were taken into account, and the bottom-line results were clear:

“We’re seeing a consistent picture. Even though most circumcised men – and their women – do not have problems with their sex lives, there is a significantly larger group of circumcised men and their female partners who experience frequent problems in achieving orgasm, compared to couples where the man is not circumcised.”

Facts:

Narrowed foreskin is popularly known as ‘Spanish Collar’ and scientifically as ‘phimosis’.

For half a century, large surveys have shown that problems with phimosis sort themselves out in childhood for up to 99% of boys. Nevertheless, this condition is still being used as a major argument for routine circumcision in many countries.

In addition, there are significantly more women with circumcised men, who experience vaginal pains during intercourse or feel that their sexual needs are not met.

Further studies needed
Frisch hopes this new study will be replicated by researchers in other countries and cultures.

“That way we can ascertain whether this phenomenon applies to Danes only or whether it extends into other cultures too,” he says. “All in all, I have a humble approach to our findings, so I would also like to see whether other Danish studies would reach the same conclusions.”

Study resonates internationally
According to Frisch, the study has received a great deal of international attention. For example, he has been contacted by politicians in California, who are very pleased with the results of the study because they want to ban circumcision in their federal state.

Others are less excited, saying the research is controversial.

“This is a highly sensitive issue, and some people oppose the publication of this kind of research. Some people have actually tried to stop the publication of our article,” he explains.

A question of ethics
Certain groups and individuals are lobbying in favour circumcising all men, explains Frisch. Not necessarily out of religious concern, but because they believe that circumcision has a health-promotional effect. In Africa, for instance, there are indications that circumcision could reduce the risk of HIV infection.

AMA Adopts New Policies During Final Day of Semi-Annual Meeting

NEW ORLEANS, Nov 15, 2011 (GlobeNewswire via COMTEX) -- The American Medical Association (AMA), the nation's largest physician organization, voted today during the closing session of its semi-annual policy-making meeting [Wacko resolutions are often passed during closing sessions of conferences, after many delegates have left.] to adopt the following new policies:

...

Stop Legal Prohibition of Male Circumcision

Ballot and other legal initiatives have recently been proposed in California that would ban infant male circumcision and penalize any physician who performed it. The AMA voted today to oppose any attempt to legally prohibit male infant circumcision.

"There is strong evidence documenting the health benefits of male circumcision, and it is a low-risk procedure, said Peter W. Carmel, M.D., AMA president. "Today the AMA again made it clear that it will oppose any attempts to intrude into legitimate medical practice and the informed choices of patients." [The patients have no choice.]

Prehistoric Men Scarred, Pierced, Tattooed Privates

Men in prehistoric Europe manipulated their privates with body art and piercings in ritual and to just fit in.[And they know this was the reason how?]

By Jennifer Viegas

Men in prehistoric Europe scarred, pierced and tattooed their penises, likely for ritualistic and social group reasons, according to a new study.

Analysis of phallic decorations in Paleolithic art, described in the December issue of The Journal of Urology, may also show evidence of the world's first known surgery performed on a male genital organ. The alteration, or surgery, might have just been for ornamental purposes, or a piercing, the researchers suggest.

Lead author Javier Angulo, chair of the Department of Urology at Hospital Universitario de Getafe in Spain, explains that, like today, tattooing and manipulation of body parts have always functioned as a way for people to express themselves.

...

Angulo and colleagues Marcos García-Díez and Marc Martínez studied male genital representations in portable, mostly handheld sizes of art made in Europe approximately 38,000 to 11,000 years ago. [A range of 27,000 years!]

The pieces, researchers say, frequently mirrored what actually appeared on the male penis. Paleolithic art is known to be very naturalistic, so the artists were recreating what they saw.

...

"It is widely understood that these designs are part of an unknown code," Angulo said, adding that some of them might have been made exclusively for a decorative purpose. Tattoos today follow the same coda, for the most part. A lion tattoo on a man's arm may only mean that the man likes the look, not that the lion means anything special to him.

Angulo added that other possible explanations for the symbols include: "territorial signs or landmarks, shamanistic repetitive marks in the passage to an unconscious world, some forms of primitive counting, the investigation of non-figurative artistic expression playing with spaces and light and darkness…Who knows?" [Who indeed?]

What is clear is that phallic decoration became more prevalent among men of the Magdalenian Culture in France and Spain about 12,000 years ago.

"That could be part of a cultural phenomenon related to a concrete time and space," Angulo said.

Another finding of the study is that prehistoric men seemed to favor preputial retraction, or drawing back of the foreskin. [Or did they just want them to look erect?] As a result, the scientists think it's likely that early males practiced circumcision as both a way to prevent disease and for affiliation purposes. To this day, ritual or religious circumcisions occur within several cultures.

["To prevent disease"? A claim made with no evidence whatever. It would have killed many more than it protected.]

...

Surprise! Men aren't keen to get (the best) part of their d*cks cut off!

Few people respond to free male circumcision surgery

By David Adetona

After weeks of hearing about the protective effects of medical male circumcision against HIV/AIDS, a number of men in the Hardap region have failed to take advantage of a government move to provide free male circumcision surgical operation at the Mariental State Hospital.

Only about 90 patients have so far been circumcised in the last two weeks since the campaign started on Monday, 31 October. The programme ends Friday (11 November).

For the first seven days of the campaign a total of 50 patients were circumcised, 10 were done on the first day, eight people the following day, 15 patients on the third day and only one turned up on the fourth day.

“The public turnout for the campaign has been poor and disappointing despite extensive information dissemination prior to starting the operations. The number of registered or booked patient is over 200, which include those from Maltahohe, Hoachanas and Gibeon constituencies,” said Dr Samuel Lyimo, the principal medical officer at the Mariental State Hospital.

Challenges experienced so far includes: last minute drop outs, indecision on whether to accept the procedure despite counseling, and fear of the safety of the surgery despite efforts to educate the community about the whole process and its importance.

After this short campaign of two weeks, the hospital said it will continue doing male circumcisions as a routine procedure to all eligible male clients and therefore patients are still welcome for counseling, education, testing and thereafter circumcision.

“The importance of this procedure and its safety cannot be overemphasized,” Dr Lyimo said. [It sure is being!]

He added that the male circumcision procedure is safe and pain free since it is done under local anaesthesia with pain killers routinely prescribed after the operation.

As part of the procedure, patients received services that included a health check, counseling and testing for HIV/AIDS, screening for sexual transmitted infections and treatment, risk reduction counseling and condom promotion.

Dr Lyimo highlighted that circumcision is one of the measures for HIV/AIDS prevention. He said studies done in other African countries have proven that circumcision reduces the risk of HIV infection by up to 60%. [Or down to 0%.]

“It also reduces the risk of infection by some other sexually transmitted infections. Therefore, the male population in the community should not fear to have the procedure done to them and or their male children since it is one of the HIV/AIDS preventive measures,” he said.

He however advised that circumcised people should still practice safe sex by using a condom if there is need to have sex.

[Well if they don't need to have sex, they don't need any protection.]

...

Freedom to decide for yourself how much (if any) of your own genitals to have cut off: priceless

Cost to keep circumcision off ballot: $100K

By Jonah Lowenfeld

In the very public fight over a ballot measure aiming to ban circumcision of underage males in San Francisco, the Jewish-led coalition that succeeded in keeping the practice legal in the city spent more than six times what the ban’s proponents did.

The Committee Opposing Forced Male Circumcision, which backed the ballot measure that ultimately was forced to be withdrawn, spent $14,000 on their efforts, according to the most recent filings with the San Francisco Ethics Commission, covering political activity through the end of September.

The same filings show the Committee for Parental Choice and Religious Freedom, the political action committee (PAC) quickly organized by the Bay Area Jewish Community Relations Council (JCRC) to wage a fight against the ballot measure, spent nearly $99,000 on its efforts.

The sum is expected to rise, JCRC Associate Director Abby Michelson Porth said, because the PAC still must be officially terminated.

“The good news is it cost us a fraction of what it would have cost had the legal victory not occurred,” Porth said. A California Superior Court judge struck the measure from the ballot in July, saying it was preempted by an existing state law.

If that hadn’t happened, Porth said, the Jewish-led coalition would have had to run a full political campaign all the way up to the Nov. 8 election. “It would have cost upward of four times what we spent,” Porth said.

For their effort, the JCRC hired four separate political firms to run the campaign. Although the Ethics Commission filings included no mention of Morrison Foerster, a firm that worked pro bono on the legal challenge that successfully struck the measure from the ballot, they did reveal that early in the campaign, the JCRC-led coalition paid $36,000 to the polling firm Tulchin Research.

“We ran a political poll to gauge how San Francisco voters felt about this measure,” Porth said, “to understand what were the key messages and messengers that would influence San Francisco voters’ attitudes.”

The JCRC itself charged the PAC over $10,000 for employees’ salaries, including Porth, who spent time working to defeat the measure.

All donations of $100 or more made to a committee on either side of the ballot measure are listed in the documents obtained from the Ethics Commission. Supporters of the JCRC-led coalition were mostly individuals and organizations in the Bay Area; the largest individual contribution came in July from Roselyne Swig, a prominent Jewish San Francisco philanthropist, who donated $10,000. National Jewish groups helped as well, among them the Anti-Defamation League, which donated $25,000 to support beating back the ban.

The effort to ban[age-restrict] circumcision, by contrast, appears in the Ethics Commission documents to have been mostly supported by in-kind, non-monetary contributions.

Art is Activism for Jupiter Sculptor

By J.W. Arnold

Michael Dulin is passionate about penises—uncut ones.

The 59-year-old Jupiter artist has long been an activist against infant circumcision and in recent years has focused his art on educating the public about the practice, which is common in the United States.
“It’s a human rights issue,” Dulin argues. “A healthy part of a healthy baby’s body is removed without his consent. He didn’t sign a consent form and his parents shouldn’t make that decision for him. It will happen a million times this year and it’s wrong.”

According to Dulin, there is a growing movement in the United States and supporters speak out in a “myriad of ways.” For him, terra cotta sculpture is the primary medium to raise awareness.

A largely self-trained artist who began at a young age, Dulin has been sculpting “intact” penises, as he calls them, and quickly gaining attention within the arts community. His works have been selected for both regional and national exhibitions. In addition to the work, he presents an artists statement outlining his motivation and perspective.

“My goal is to raise awareness. People need to be made aware there is nothing wrong with foreskin,” he says. “It’s a natural part of the body and most people think it’s natural to be mutilated or circumcised. It’s not normal.”
Dulin, who was circumcised as an infant, first began aware of his own condition at the age of eight. He was bathing and noticed the brown ring around his penis and asked his mother about it. She told him “Jesus was circumcised,” and that was the end of the conversation, he recalls. “It was just done in the 1950s….often without even consulting the parents.”

Years later, when Dulin married and started having children with his wife, he took note: “I’m glad my first child was a girl. In the next bed at the hospital there was a woman who had just had a baby boy. The husband had just videotaped the circumcision and was bragging about how the kid screamed and blood spurted everywhere. He said he couldn’t wait to show the video to his son when he was old enough. The fool was so proud of it.”

Dulin fathered three sons before coming out and is proud that each is intact.

“When we had boys, they never left my sight while they were in the hospital,” he says. “Now they are happy, healthy, well adjusted young men and have never had any problems with their foreskins.”

While uncut penises are considered a fetish in the gay community, Dulin has not found everyone to be supportive of his cause. Several years ago, Dulin marched in a New York City gay pride parade under the banner of Intact America, an anti-circumcision group, and found the group heckled by announcers from the reviewing stand.

“He may have been trying to be catty, but there are no jokes that would make me laugh about circumcision. It’s crude and rude to joke about a victim of an atrocity. We don’t laugh at women who lose a breast to cancer,” he insists.

Dutch Chief Rabbi Not Alarmed by Doctors' Circumcision Campaign

By Tamar Runyan

Faced with a full-on media blitz by the Royal Dutch Medical Association (KNMG) to sway public opinion against the ritual circumcision of infants, Dutch Chief Rabbi Binyomin Jacobs is choosing a cautious route in response, emphasizing that, the views of the Netherlands’ top medical body notwithstanding, Jewish circumcision is not in danger.

For the past couple of months, KNMG has published op-eds in local newspapers discouraging the circumcision of minors when not medically necessary, and calling on politicians, insurance companies and human rights organizations to help end the practice. The effort follows the publication last year of a 20-page report by the association that urged doctors to emphasize the risks of circumcision with their pediatric patients’ parents.

But Jacobs, a Chabad-Lubavitch emissary who is currently immersed in a campaign challenging a legislative push to ban kosher animal slaughter, says that the current atmosphere in the Netherlands leads him to believe that there’s no need to be alarmed.

“We’re not ignoring the situation,” he stresses. “We’ll see what happens and remain alert.”

According to Jacobs, only about 50 Jewish baby boys are circumcised each year. Though there are between 20,000 and 30,000 Jews in the Netherlands, most are older or without children.

The KNMG’s stance is contradicted by the American Academy of Pediatrics, which states in a policy statement reaffirmed in 2005 that “parents should determine what is in the best interest of the child.” [Yes, to the AAP's shame.]

Jacobs is quick to point out that most of those leading the current campaigns against circumcision on the one hand, and animal slaughter on the other, could not be accused of anti-Semitic animus. In the case of circumcision, he says, the best strategy at the current time is one of quiet persuasion.

“There is no sign,” he states, “that this will be taken up by the government.”

Is Your Circumcision Making You Soft?

Researchers surveyed 300 men and found that circumcised fellas had a 4.5 times greater chance of suffering from ED than noncircumcised guys.

One reason: Circumcised penises can experience up to a 75 percent reduction in sensitivity compared to non-snipped members, according to a study published in the British Journal of Urology International.

A major factor that contributes to that loss of sensitivity is the severing of the perineal nerve—a nerve located on the underside of the penis that is responsible for the majority of sexual sensory input—explains Dan Bollinger, study author and director of the International Coalition for Genital Integrity.

Keep the findings in perspective, though. This was only a survey, so some of the men could be fibbing. [This is a criticism of all surveys - how to extract the truth from men about their potency? Why should intact men lie more about their potency than circumcised men? The study actually found circumcised men were 4.5 times more likely to use an ED drug, which is less shaming than admitting to ED. The real issue is not that it was a survey, but the possible bias of self-selection.] And there are numerous other factors that contribute to ED.

“Aging, diabetes, obesity, cigarette smoking, and poor diet—these are all going to affect you and your chances of ED more than being circumcised will,” says Judd Moul, M.D., professor and Chief of the Division of Urologic Surgery at Duke University Medical Center.

[When did anyone last remind people to keep all the other factors in mind when an article was making claims about the benefits of cutting genitals? And this is Men's Health. What can Prof. Moul say to a young, non-diabetic, slim, non-smoking, healthy-eating circumcised reader with ED?]

Dutch Jews and Muslims fight for circumcision right

Religious groups in the Netherlands have opposed a call from the Royal Dutch Medical Association (RDMA) for male circumcision to be banned discouraged.

Male circumcision is legal in the Netherlands but the body representing the country's doctors wants to end the practice.

The association is urging politicians to put it on the political agenda.

It is asking parents to think twice before having their sons circumcised because it regards the procedure as dangerous and unnecessary.

Yet others see it as the latest reflection of a political shift in a country that is increasingly pressuring religious groups to stop practising what they preach.

Growing opposition

... Gert van Dijk is a medical ethicist and one of the authors of the RDMA's anti-circumcision advice.

'We feel circumcision is a medically unnecessary form of surgery. The patient has to give consent, but children can't give consent and we feel that is wrong and a violation of the child's rights," he said.

"In our code of medical ethics, it states that you must not do harm to the patient, but with this procedure this is exactly what you're doing."

Religious freedom

The RDMA are fighting against what is a deeply entrenched religious practice.

It is written in the Islamic text the Hadith that Muslim men should "cut the things that grow".

Ibrahim Wijbenga ... thinks claims that these discussions are medically motivated are nonsense and is campaigning to save the practice.

...

"The motivation is plain Islamophobia. It's not a discussion about medical ethics, it's to make a lot of bad propaganda against Muslims and about our way of life and our religion," Mr Wijbenga said. "Basically, it's an effort to stop Muslims from entering Holland."

Jews, too, fear these anti-circumcision discussions are a serious threat to their faith.

... Rabbi Jacobs, one of the Netherlands' most senior religious leaders... said that being advised not to circumcise babies would have a dramatic impact on the estimated 30,000 Jews living in the Netherlands. For him, it is worse than being told they cannot cultivate kosher meat.

'I can import (kosher meat) or choose to not eat it, but with circumcision I'm stuck. Even if I take my child to a different country to do it, once I come back the doctor will see that there has been a circumcision and put me in jail.

"If you interfere with this practice, it will totally end the Dutch Jewry in the Netherlands."

Rights of the child

Even within the Jewish community, some - albeit a tiny minority - believe circumcision can leave a lasting psychological as well as a physical scar.

"He's grabbed, his legs are pulled apart, and they cut off part of his penis. Now what does it do to the boy's mind? I think it's wrong. I think boys or men have to decide for themselves."

Michael Schaap is speaking from experience. His Jewish parents had him circumcised as a baby. He believes it is "morally wrong to cut off any part of another person's body when there is no medical reason to do it. It's mutilation".

Michael made the controversial documentary "Mum, Why Was I Circumcised?" partly motivated by the anger he felt throughout his teenage years.

"When you do it with a boy, there's no way back. I don't know how sex would be with a prepuce. It made me angry that somebody else decided for me, to do something that I probably would not have done if I was deciding for myself."

Politicians here in The Hague have yet to respond to this increasingly intense public debate, which coincides with the imminent outlawing of ritual slaughter and the proposed burka ban.

Now many Muslims and Jews are concerned their fundamental traditions are under threat and that circumcision may be the next element of religious freedom to be withdrawn.

And that is essentially what makes this such a fiercely contentious issue: the rights of the child versus the rights of religion. [But what can it mean to say that religion - an abstraction - has rights?]

Decrease seen in nation's circumcision rates

By Rick Ruggles

The decision on whether to circumcise a baby boy may soon have a sharper edge for parents.

Circumcisions appear to be declining nationwide and some physicians have observed a decrease in the metro area as well. Parents increasingly question whether the procedure is necessary and decide not to alter their boy's anatomy before he has a say in the issue.

The discussion of circumcision, typically held quietly among parents and their physician, commanded San Francisco's attention this year before a judge removed from the city's ballot a proposal to outlaw it.

Now, two national health organizations are giving the topic another look, four years after the World Health Organization decided that adolescent males and adult men in a large portion of Africa should be circumcised to combat an HIV epidemic there.

Meanwhile, anti-circumcision groups are using the Internet to distribute their views and find new followers.

"It's a human rights issue," said Janet Tilden of Omaha, a state spokeswoman for NOCIRC, a nationwide anti-circumcision group.

Parents who permit circumcision have made "a permanent decision for their son, and he has no say in the matter."

Tilden, who has two uncircumcised sons, and others who oppose circumcision say there is no good medical reason for the procedure. They say foreskin isn't a defect and that circumcision can actually harm the baby.

Nicole Johnson of Bondurant, Iowa, has a 5-week-old and a 2-year-old boy. Each was circumcised shortly after birth at Mercy Medical Center-Des Moines. Her father wasn't, she said, and he had a yeast infection that he attributed to not being circumcised.

But her husband was circumcised, and they decided to have their boys circumcised, too.

"I think it's pretty much the norm," Johnson, a social worker, said.

Male circumcision seems to be in decline in the United States. The CDC examined four sets of statistics in the United States and found that while newborn male circumcisions increased from 48 percent in 1988-91 to 61 percent in 1999-2000, three studies from about 2000 through 2009 found declines in circumcisions in the U.S.

Voters in San Francisco expected to decide next week on a proposal to make circumcision illegal, but a judge there ruled that the regulation of medical procedures is a state issue, not a city issue. The judge ordered that the proposal be removed from the ballot.

Now a California state proposal would make it clear that a local law couldn't restrict circumcision.

Dr. Tina Scott-Mordhorst, clinical associate professor at the University of Nebraska Medical Center, said circumcisions have dropped in the metro area, too. "Far more are uncircumcised now than 13 years ago," Scott-Mordhorst, a pediatrician, said.

She said she stopped performing them four years ago because there are fewer to do and obstetricians generally do the ones that are requested.

Dr. David Kaufman, a pediatrician with Children's Physicians in Omaha, said he brings up the subject of circumcision with parents who are about to have a baby boy. Kaufman is like most physicians who perform circumcisions. He asks the parents to decide.

"Do I tell them they really should have a circumcision? No, I don't," he said.

[Then why does he bring it up?]

Dr. Amy Stier, a pediatrician at the University of Iowa Children's Hospital, said through an email message that most Iowa City-area parents still have their boys circumcised.

"I tell parents right off the bat that it is up to them," Stier said. "We don't recommend or discourage the procedure, because there are very small benefits and very small risks."

Physicians say the risks of the short surgical procedure include bleeding, infection, scarring and trauma to the organ. The benefits include reduction of a slight risk of urinary tract infections among infants, less risk of a rare form of penile cancer and less risk of contracting sexually transmitted infections such as HIV.

A physician with the World Health Organization said last week in an interview that he believed it would be wise for infants worldwide to be circumcised. They should, however, be performed in safe, hygienic conditions and there should be no family history of severe bleeding, as occurs with hemophilia.

"If all of the conditions are there, yeah, why not?" said the WHO's Dr. Rafael Mazin.

[If you want to know why not, look around.]

Although neither the federal Centers for Disease Control nor the American Academy of Pediatrics is expected to make huge changes in fairly neutral stances on circumcision, their recommendations are bound to increase awareness of the issue. One AAP physician said there is more evidence available that circumcision reduces the risk of HIV, and the academy's recommendations "may be a little less neutral" than before.

The academy in 1999 wrote that evidence indicated there might be medical benefits to newborn circumcision, but the data weren't sufficient to recommend it routinely be done.

Dr. Douglas Diekema, a professor of pediatrics at the University of Washington, said research over the past 12 years has indicated that circumcision reduces the risk of contracting HIV and human papilloma virus. The AAP most likely will make that point more clearly, Diekema said.

[More clearly like, no protection and possibly greater risk to women; no protection to the biggest group at risk from sexual transmission, gay men; and only slight reduction if any in the risk to heterosexual men?]

Diekema, who is on the AAP committee reviewing circumcision recommendations, said he still feels there's not enough benefit to recommend that all baby boys be circumcised.

Reported increase in practice of female circumcision raises alarm

By JJ Robinson

Claims that female circumcision is rising in practice in the Maldives have triggered alarm across the government and NGO sector.

“We are beginning to hear reports of this occurring, and I have heard on radio and television people justifying the practice. It is quite disheartening,” said Vice President Dr Mohamed Waheed Hassan, speaking at a UN event last week.

Then-Attorney General Husnu Suood raised concern in December 2009 that female circumcision in the name of Islam had been revived in Addu Atoll, claiming that religious scholars “are going around to midwives giving fatwas that girls have to be circumcised. They’re giving fatwas saying it is religiously compulsory. According to my information, the circumcising of girls has started and is going on with a new spirit.”

...

A source from the Health Ministry’s Department of Gender and Family Protection told Minivan News that while female circumcision was widely known to have occurred in the Maldives, it stopped in the 80s and 90s but “now we are hearing media reports that it is happening again.”

...

Deputy Health Minister Fathimath Afiya meanwhile confirmed that the Ministry was sufficiently concerned to launch a study seeking to identify where female circumcision was occuring.

For Young Women, a Horrifying Consequence of Mubarak’s Overthrow

By Betwa Sharma

Cairo—Ali, a 34-year-old Cairo businessman who asked that his real name not be used, is weighing whether or not to circumcise his 12-year-old daughter. Female circumcision, or female genital mutilation (FGM), as it is also known, involves removing part or the entire clitoris. In more severe forms of the procedure, the labia minora is removed and the vaginal opening is stitched up. Ali’s wife has told him about her own experience; describing her story to me, he said, “It is her most terrible memory.” He has heard discussions on television of potential harm the procedure can cause, but he feels a responsibility to protect the chastity of his daughter until she is married. Three thousand years of tradition instruct him that circumcision is the best means to this end. And, in the post-Mubarak Egypt, there are fewer and fewer voices offering an alternative view. The decades-long movement to stop FGM has become a casualty of the power struggle in Egypt.

The campaign to end FGM in Egypt was fighting an uphill battle before the revolution. Although FGM was outlawed in 2007 after a 12-year-old girl died from the procedure, the practice is still widespread. Despite efforts to reduce it, the number of girls aged 15 to 17 who underwent FGM only dropped from 77 percent in 2005 to 74 percent in 2008, according to the 2008 Egypt Demographic and Health Survey (EDHS). EDHS also showed that 91 percent of all women in Egypt between the ages of 15 and 49 have undergone FGM. The practice is common not only among Muslims, but also in the Christian community, which constitutes 10 percent of the Egyptian population. A sanitized version of FGM has gained increased prevalence in recent years, presenting additional challenges. In 1995, only 45 percent of all FGM operations were conducted by doctors; by 2008, the percentage had risen to 72 percent. A young woman working as a maid and living in Cairo, who asked to be referred to only as Ayesha, did not even know that FGM is illegal. Her mother had put her through the procedure, and she told me that she would do the same. (Experts have found that the practice is mostly perpetuated by mothers making decisions for their daughters.) “Unless someone can show me what is wrong with it I don’t think there is any reason to change,” she said.

Since the revolution, international support for this fight has significantly waned. Political instability has led to a 75 percent cut in Egypt’s FGM-related donor funds to the United Nations since January, according to Marta Agosti, the head of the anti-FGM program for the U.N. Changeover among government ministers has also slowed official work. The National Council for Childhood and Motherhood, the government body charged with addressing the problem, was shuttered after the revolution, ...

In addition to the general shrinking of U.N. and NGO funds and efforts, the rise of the Muslim Brotherhood as one of the strongest political forces attempting to fill the void left by Mubarak’s departure presents potential obstacles to the campaign to end FGM. While the Muslim Brotherhood does not have an official position on FGM, the group has, in the past, opposed a complete ban on the practice. “Nothing in Islam forbids circumcision,” said Saad El Katani, the leader of the Brotherhood in parliament in 2008. ...

In addition, activists are also fighting the shadow of Suzanne Mubarak, who, for all her husband’s transgressions, was a force behind the campaign to end FGM. As the former dictator’s wife,Mubarak gave speeches and organized conferences opposing the practice, making her one of the most recognizable faces in the international fight against FGM. She played a key role in getting Christian and Muslim religious leaders to forbid the procedure, which had a far greater impact than the legal ban. After declaring their position, the fatwa office in Cairo—the office of the Grand Mufti of Egypt—set up a hotline; several anecdotes emerged about women changing their decision to go ahead with the practice based on advice they received from this hotline. Activists assert that their efforts to eliminate FGM were well underway before Suzanne Mubarak demonstrated interest in the issue. “We didn’t wait for Madame Mubarak to talk about FGM,” Sidhom Magdi, head of the Egyptian Association for Comprehensive Development, told me. But they do not deny that her involvement gave the movement political momentum that it had previously lacked.

Now, however, anything attached to the Mubaraks’ legacy is, if not explicitly tainted, an easy target. Civil society groups characterize Mubarak’s efforts as self-promoting. “She was devoid of a feminist vision or a socialist vision,” said Nihad Abu Kumsan, a lawyer and head of the Egyptian Centre for Women’s Rights. Hassan insists that FGM-related figures were exaggerated by the Egyptian government so that the former first lady could pocket international funds.

...

The U.N., aware of that the issue is a minefield, is also keeping a low profile for the time being. “We have to be very careful right now as we don’t want the issue to be captured by the ultra-orthodox,” said Agosti, expressing a fear that the U.N. will be characterized as an agency promoting the Western agenda or worse, Mubarak’s legacy.

Ali, the Cairo businessman, and his wife ultimately decided against FGM for their daughter. “We don’t want to change what God has created,” he told me.

(WASHINGTON D.C.) - Journalists have professional and ethical obligations to present different views on controversial issues. Unfortunately, most reporting on the topic of male infant circumcision tends to be virtually one-sided, claiming a debatable potential health benefit, and ignoring the inherent harm of this genital surgery. We the undersigned want balanced reporting on circumcision.

Parents sometimes make a circumcision decision that they later deeply regret. Many parents are unaware that among the harmful effects of circumcision are significant pain and trauma, behavioral and neurological changes in infants, potential parental stress from persistent crying of infants (colic), disrupted bonding between parent and child, loss of a natural, healthy, functioning body part, and risk of surgical complications. In the long term the consequences of circumcision include reduced sexual pleasure, potential psychological problems, and unknown negative effects that have not been studied. For these reasons, some doctors refuse to perform circumcisions because of ethical considerations. Clearly, there is plenty of information about circumcision harm that is not being reported.

The pro-circumcision bias in American culture and media reflects the pro-circumcision bias in American medicine. This bias influences who chooses to study circumcision, what questions are studied and what questions are ignored; and which studies are approved for publication. Most American medical studies that assess the advisability of circumcision focus on the search for a presumed benefit. (For example, they refuse to study circumcision and erectile dysfunction. A survey in a men's health journal found that circumcised men were 4.53 times more likely to use an erectile dysfunction drug.)

...

We urge you to keep journalism principles in mind when reporting about circumcision and take the following steps:

Doctor cleared of wrongdoing in botched circumcision

By Mark Hilliard

A DOCTOR accused of asking an "inexperienced" surgeon to perform a circumcision that went wrong was cleared of any wrongdoing at a Medical Council hearing yesterday.

Dr Timothy Buckley, of Mullingar General Hospital in Westmeath, had denied acting in poor judgment before the botched operation on a seven-year-old boy, who has since had three corrective surgeries on his penis.

Yesterday, Dr Buckley was cleared of delegating a procedure to someone who wasn't adequately qualified and failing to give adequate supervision.

The family of the boy - who was not named to protect his identity - said afterwards that they were disappointed by the outcome.

On July 6, 2009, Dr Buckley's registrar surgeon Dr Arshad Hussain carried out a circumcision operation on the boy. The patient developed a paraphimosis -- a severe tightening of the foreskin around the glans of the penis.

[So circumcision can cause paraphimosis. An earlier story says the boy's penis became partially necrotic (died).]

A fitness-to-practise inquiry at the Medical Council in Dublin yesterday heard claims that Dr Hussain did not have the experience necessary to carry out the procedure alone and that he was not supervised properly.

The registrar surgeon had only been based at Mullingar Hospital for five days before being given the operation. He had assisted in other circumcisions in Ireland but not on an independent basis.

Dr Hussain said he did have prior experience in Pakistan.

At a previous hearing, expert witness Dr Gordon Watson, a consultant surgeon, had said that given the level of Dr Hussain's experience he would not have delegated the procedure to him and, had he, he would have supervised it more thoroughly.

But yesterday an expert witness appearing on behalf of Dr Buckley, consultant surgeon Dr Ronan Waldron, contradicted this and said he felt the registrar was amply experienced.

"I would certainly expect a registrar to be able to perform a circumcision," he said.

The fitness-to-practise committee found that neither charge could be proven beyond a reasonable doubt and cleared Dr Buckley of poor professional performance.

The Health Ministry has spoken out against criticism by women’s rights activists and health experts of a ministerial guideline on female circumcision, saying the instruction was issued specifically to combat genital mutilation.

Ministry spokeswoman Murti Utami said that many families, especially in rural areas, still believed in the importance of circumcising female babies for religious reasons.

“I would like to stress that female circumcision is not genital mutilation, which is indeed dangerous. They are two things that are very different,” she said on Friday.

In June, community organizations spoke out in a letter to the government, opposing the ministerial instruction, which directs health professionals not to cut a girl’s genitals but to “scrape the skin covering the clitoris, without injuring the clitoris.”

Medical experts also spoke out against the ministry’s move. “This will give doctors a new motivation to circumcise [girls] because now they can say the Ministry of Health approves of this, and the Indonesian Council of Ulema [MUI] approves of it,” said Jurnalis Uddin, a doctor and lecturer at Yarsi University in Jakarta.

On Friday, Murti said the ministerial instruction, which was issued in June, governed procedures for female circumcision in cases where it is deemed necessary by families. It did not constitute government support for the practice, she claimed.

Murti added that the guidelines provided directions on performing the procedure properly and safely and required that circumcision must only be carried out with parental consent. Furthermore, parents must be given information beforehand on pros and cons of the procedure.

Circumcision is typically done at birth, or before a girl reaches the age of 5. Traditionally, the procedure was mostly symbolic, with a small cut made on the clitoris, or by rubbing it with tumeric root.

However, Uddin said he had found that when medical practitioners performed the procedure, there was a trend toward more extensive cutting of the clitoris.

Chimp to Man to History Books: The Path of AIDS

By DONALD G. McNEIL Jr.

Our story begins sometime close to 1921, somewhere between the Sanaga River in Cameroon and the Congo River in the former Belgian Congo. It involves chimps and monkeys, hunters and butchers, “free women” and prostitutes, syringes and plasma-sellers, evil colonial lawmakers and decent colonial doctors with the best of intentions. And a virus that, against all odds, appears to have made it from one ape in the central African jungle to one Haitian bureaucrat leaving Zaire for home and then to a few dozen men in California gay bars before it was even noticed — about 60 years after its journey began.

Most books about AIDS begin in 1981, when gay American men began dying of a rare pneumonia. In “The Origins of AIDS,” published last week by Cambridge University Press, Dr. Jacques Pépin, an infectious disease specialist at the University of Sherbrooke in Quebec, performs a remarkable feat.

Dr. Pépin sifts the blizzard of scientific papers written about AIDS, adds his own training in epidemiology, his own observations from treating patients in a bush hospital, his studies of the blood of elderly Africans, and years of digging in the archives of the European colonial powers, and works out the most likely path the virus took during the years it left almost no tracks.

Working slowly forward from 1900, he explains how Belgian and French colonial policies led to an incredibly unlikely event: a fragile virus infecting a small minority of chimpanzees slipped into the blood of a handful of hunters, one of whom must have sent it down a chain of “amplifiers” — disease eradication campaigns, red-light districts, a Haitian plasma center and gay sex tourism. Without those amplifiers, the virus would not be what it now is: a grim pilgrim atop a mountain of 62 million victims, living and dead.

In the early 1980s, Dr. Pépin was a young doctor fighting a sleeping sickness epidemic at a hospital in Nioki, in what was formerly the Belgian Congo, then Zaire, and is now the Democratic Republic of Congo. The virus was then unknown in Africa, but his work gave him clues that would later help him on its trail.

In retrospect, he says in his book, he may have inadvertently infected some of his patients. Ideally, the glass syringes used in Nioki were sterilized in the hospital’s autoclave. But with the electricity often out, nurses boiled them instead. “And I did not pay too much attention to how long they were boiled,” he said in an interview.

Later, he worked in Guinea-Bissau on H.I.V.-2, which is related to H.I.V.-1 but causes a milder and harder-to-transmit form of AIDS that some victims live with for decades. Noting that cases were more common among older people, he concluded that it was dying out. If sexual transmission among young people was not keeping it alive, he reasoned, some other route must have first made it so widespread among the elderly. He suspected the aggressive campaigns that colonial doctors waged against syphilis, yaws, leprosy, tuberculosis and other ills until independence arrived in the 1960s. They all used injections, since pill versions of many antibiotics did not exist or were costly.

In 2005, Dr. Pépin began field studies. By sampling the blood of Africans 55 and over, he showed that those who had many injections in their youth or had undergone ritual circumcision, in which many boys were cut with the same blade, often had antibodies to hepatitis C or HTLV, a little-known virus that, like H.I.V.-1, comes from chimps and infects the CD4 cells of the immune system, but is harmless.

That was hard evidence that blood and syringes had spread other viruses.

...

In brief, his recounting of the epic journey is this:

In nature, only about 6 percent of troglodytes chimps are ever infected. Within a troop, each female mates with many males, but mating with outsiders is rare, so most troops are untouched while a few are heavily infected.

H.I.V.-1’s four genetic groups, M, N, O and P, show that it made the chimp-human jump at least four times in history. But group M accounts for more than 99 percent of all cases.

Why did only one spread?

Molecular clock dating shows that M reached humans somewhere near 1921. Chimpanzees are too big and agile to be hunted with anything but guns, which until the 20th century were almost entirely in white hands.

Using colonial census data, surveys of how modern bush-meat hunters butcher kills, and infection rates among nurses stuck by dirty needles, Dr. Pépin calculates that, in the early 1920s, a maximum of 1,350 hunters might have had blood-to-blood contact with troglodytes chimps. Only 6 percent of the chimps — about 80 — would have been infected, and fewer than 4 percent of the scratched hunters probably could have caught it. That would suggest only three infected hunters at most.

Given how inefficient most sexual spread is — in some cases, a husband and wife can have sex for months without passing H.I.V. — sex alone would not have let three hunters, or even a dozen, pass on their virus to today’s millions, he argues. There must have been an amplifier.

Studies among heroin addicts — he cites examples from Italy, New York, Edinburgh and Bangkok — show that blood transmission is 10 times as efficient.

In the 1920s, machine-made glass syringes replaced expensive hand-blown ones, and the Belgians and French attacked many diseases in their colonies, both out of paternalism and to create herd immunity to protect whites. Patients might get up to 300 shots in a lifetime. Other diseases have spread this way; an Egyptian campaign against schistosomiasis ended in 1980 after giving more than half its “beneficiaries” hepatitis C.

Thus, one hunter’s group M infection could have become dozens. Then Dr. Pépin’s focus shifts to the twin cities facing each other across the Congo: Leopoldville (now Kinshasa) on the Belgian side, Brazzaville on the French.

They are the epidemic’s cradle; viral diversity is highest there, and the earliest positive blood sample, from 1959, was found there.

... until 1960, brothels were rare. Most of the women were “femmes libres” — escapees from rural polygamy who typically had only three or four clients for whom they also cooked and did laundry.

...

Since femmes libres had few partners, viral spread was probably sluggish, although occasional hepatitis outbreaks were noted at clinics where prostitutes got penicillin shots for syphilis — suggesting amplification by needle there, too.

... when whites fled the chaos of independence, economies collapsed. Poverty was rampant.

... competition forced desperate women to have sex with up to 1,000 clients a year, and venereal disease treatment dried up. There must have been a viral explosion like the one that happened 20 years later in a closely studied band of prostitutes in Nairobi: In 1981, 5 percent of them had the virus; three years later, 82 percent did.

The next link was Haiti.

...

Once again, Dr. Pépin argues that rapid expansion through sex alone is mathematically impossible and that there must have been an amplifier. He believes the culprit was a Port-au-Prince plasma center called Hemo-Caribbean

...

Hemo-Caribbean’s co-owner was Luckner Cambronne, leader of the feared Tontons Macoutes secret police. Nicknamed the “Vampire of the Caribbean,” Mr. Cambronne, who died in 2006, bled 6,000 sellers who were paid as little as $3 a day and exported 1,600 gallons of plasma to the United States each month, according to an article in The New York Times.

... Dr. Max Essex, chairman of the AIDS Initiative at the Harvard School of Public Health, ... said. “This is very scientifically hard, objective scholarship.”

Dr. Allan Ronald, a University of Manitoba AIDS expert who began the Nairobi prostitute study, also read an early version and called Dr. Pépin “one of the unsung heroes of AIDS research.”

While others had speculated that syringes amplified the virus, he said, “Jacques did the studies among elderly people that were needed.”

...

But always, the primary reason for circumcision-revision is - circumcision!

AAP: Need to Re-Do Circumcision Rises, Reasons Unclear

BOSTON -- An unexplained increase in the number of revision circumcisions has pediatric urologists wondering whether the finding is real and, if so, what caused it.

Data contributed by pediatric hospitals nationwide showed a 119% increase in the rate of revision circumcision procedures from 2004 to 2009.

In contrast, the rate of primary circumcision increased by 19%, and procedures to remove penile adhesions rose by 37%.

Closer inspection of the data showed wide variation by hospital in the rate of revision circumcision during the study period, Paul J. Kokorowski, MD, reported here at the American Academy of Pediatrics meeting.

"We found that certain hospitals had dramatic rises in revision circumcision procedures [approaching 1,000% in some cases] while others had more modest increases," said Kokorowski, of Children's Hospital Boston.

The analysis included 34,568 patients who underwent one of the targeted procedures. The total consisted of 5,632 revision circumcisions, 25,768 primary circumcisions, and 3,168 procedures for lysis of penile adhesions.

The 119% increase in the volume of revision circumcision at the participating hospitals stood out as significantly greater than the increases in the other two procedures (P<0.001).

The rate of revision procedures increased in a near-linear manner over the period reviewed, starting with a 17% rise from 2004 to 2005 and then to 47% for 2006, 71% for 2007, 91% for 2008, and 119% for 2009.

[This is presented confusingly, and would benefit from showing the raw data.]

In contrast, the rate of primary circumcisions peaked at 22% to 23% during 2007 and 2008 before declining to 19% above the baseline level.

The rate of adhesion-lysis procedures declined by 11% from 2004 to 2005, peaked at 45% above baseline in 2007, and then descended to 37% in 2009.

In an effort to determine factors contributing to the increased rate of revision circumcision, investigators performed an analysis limited to 13 hospitals that provided complete data on the three penile procedures for every year of the study period. They found no consistent patterns.

The findings left unanswered the question of what caused the large increase in revision circumcision procedures over a five-year period.

[One reason could be that the Internet and porn are giving parents a better idea of what a "normal" circumcised penis "should" look like, and they are becoming more critical of what has been done to their sons.]

"Revision circumcision does seem to be more common at specific PHIS hospitals and this might represent a more overall increase in revisions," said Kokorowski. "Unfortunately, due to the limitations of our dataset, we can't speculate on the reasons for this change."

October 11, 2011

Tara Klamp salesman gave Zulu king R1m [$US125.75K] car

An expensive gift has cast new shadows over the Kwazulu-Natal (KZN) Department of Health's controversial decision to purchase and use an unsafe circumcision device called the Tara KLamp. In addition, a promised assessment of the clamp has not materialised, the clamp is still being used, and more adverse events are being reported.

In 2010, we published a four-part story about the KZN government rolling out an unsafe circumcision device called the Tara KLamp. We concluded:

"This is a terrible situation. Companies selling the Tara KLamp are making money by inflicting injuries and suffering. The KZN government's adoption of the clamp is, in the best case scenario, deeply suspicious and unscientific."

We did not have evidence of corruption and so left matters at that.

On 18 September the Zulu edition of the Sunday Times newspaper reported that a businessman, Ibrahim Yusuf, had given King Goodwill Zwelithini a car worth R1 million [$US 125,750]. According to our translation, Yusuf said that he had given the king the car as a symbol of respect and that he had not met the King before their meeting at the reed ceremony.

Yusuf is the director of Intratrek Properties, the company that sold the Tara Klamp devices to the KZN government. The Mail & Guardian has written about Yusuf's murky past here and here.

In July 2010 the Treatment Action Campaign (TAC) wrote to the KZN MEC for Health, questioning the use of the unsafe Tara KLamp device. He responded:

"What we have explained to the Minister and now indirectly to you is that we are committed to massive Medical Male Circumcision in KZN as directed by His Majesty our King. We will do it medically as the Majesty instructed us. The king has instructed us that no one should die as a result of our MMC intervention but he did not instruct us that no one should have pain."

We found this response disturbing for many reasons, not least because an elected provincial government is not supposed to take orders from a traditional leader. But it is also strange that when confronted about the clamp, the MEC chose to invoke the king - thus raising the question, was the king involved with the decision to use the clamp in the first place?

The manner in which these devices were purchased was suspicious long before the story of Yusuf's gift to the king came to light (see this Mail & Guardian report.) For example, there was no tender advertised for the Tara KLamp. Yet TAC had purchased a Tara KLamp from another provider at a lower price than the KZN paid for its bulk orders. Even though we requested it, we were never shown the justification for purchasing the Tara KLamp - which is both more expensive and, more importantly, much riskier than standard circumcision.

Oblivious to the facts

When TAC wrote to the KZN Health Ministry in July 2010 we outlined our concerns with the use of the Tara KLamp. In their response, and in a subsequent meeting with the KZN premier and Health Department officials in late 2010 they dismissed our concerns. This was despite us presenting two men who had experienced serious adverse events to the meeting. We also published cell phone video footage of two other men who had experienced serious adverse events due to the clamp. We have recently learned of more men who have experienced severe adverse events, some of whom had to be hospitalised.

...

That no trial has taken place or will take place is confirmed by a presentation that Tim Farley, until recently of the World Health Organization, delivered at the International AIDS Society Conference in Rome earlier this year. According to the slides from his presentation, no further trials are planned.

The national government also set up a task team, with WHO assistance, to look into the Tara KLamp. Nothing seems to have come of it.

In a September 2011 report from the KZN Department of Health the only mention made of the Tara KLamp is to argue that it is cheaper than standard circumcision. The price breakdown given lacks detail and so we cannot analyse it. A circumcision expert told us plainly it's "crap". In our earlier article we gave a detailed breakdown of the cost involved and the clamp was significantly more expensive.

Health Minister Aaron Motsoaledi assured the public last year that the clamp would only be used in KZN. We are worried however because we have been informed that the Tara KLamp is being promoted to representatives of various other provinces.

Voluntary medical male circumcision is an important intervention that can prevent many new HIV infections. It is tragic that the sellers of the Tara KLamp along with members of the KZN government are undermining it by continuing to use this dangerous device. There needs to be an inquiry into why and how the KZN government purchased it.

Not a surgical vaccine: Circumcision not appropriate for HIV control in Australia

A paper in the Australian and New Zealand Journal of Public Health argues that circumcision of baby boys has no place among HIV control measures in Australia. Researchers Robert Darby and Robert Van Howe said that there was nothing in the results of the African circumcision trials to justify circumcision as an HIV control measure in developed countries, nor to warrant circumcision of infants rather than adult men. “Quite apart from the ethical problem, today’s infants would not be at risk of any sexually transmitted infection until they become sexually active in 16-20 years time. By then both prevention and treatment options, as well as the virus itself, may well have changed beyond recognition”, Dr Darby said.

In their paper the authors reviewed recent suggestions that widespread circumcision of male infants be introduced in Australia as a means of combating heterosexually transmitted HIV infection. They found them flawed in several crucial areas. These include doubts about the African trials themselves, their relevance to Australia, the risks and harm of circumcision, and issues relating to informed consent and human rights. They also criticised the notion of circumcision as a “surgical vaccine” as unscientific and irresponsible from a public health point of view. “Such an exaggerated claim is likely to encourage high-risk behaviour”, Dr Darby said.

The proposals under review were largely inspired by three clinical trials in Africa. But Dr Darby said the public health situation is dramatically different in a wealthy, developed nation such as Australia. “There is no heterosexual HIV epidemic in Australia that would justify a costly, authoritarian program on the scale suggested,” he said. “On the contrary, our analysis supports the conclusion of the Royal Australasian College of Physicians, in its policy statement on circumcision, that routine circumcision is not appropriate in the Australian and New Zealand context.”

Female circumcision

AD reports that the Dutch Physicians Association and women's organisations have been angered by a lawyer urging the Dutch government to legalise a 'minor form of female circumcision'. Wouter Limborgh's doctoral thesis, presented at Erasmus University recently, called on the government to legalise a 'minor' form of female circumcision because "cultural freedom should take precedence." [...over human rights?]

AD writes that female circumcision is banned in the Netherlands and for good reason; a spokesperson for the Dutch Physicians Association tells the paper, "all forms of unnecessary surgery on children violates their rights."

Circumcision jury finds in doctor's favor

By Douglas Walker

MUNCIE -- After a little more than an hour of deliberations, a Delaware Circuit Court 4 jury on Thursday determined that a local physician should not pay damages as a result of circumcising an infant in 2003.

The jury - made up of three men and three women - found in favor of physician Michael R. Burt, and against the now-7-year-old youngster and his mother, whose attorney on Thursday suggested they should receive damages in excess of $400,000.

This week's four-day trial resolves a lawsuit filed in November 2005. The boy and his mother had earlier reached an out-of-court settlement with Ball Memorial Hospital, where the birth and circumcision took place.

Burt this week acknowledged his mistake in performing the procedure on the boy, a day after his birth at the Muncie hospital. In her lawsuit, the child's mother said she did not want her child circumcised, saying her family believed "genital integrity is a basic human right."

The suit also called the circumcision "an intentional battery."

[Many commentators have scoffed at this, but it is a strict legal term for what was done.]

Burt's attorneys - Benjamin Ice and Edward L. Murphy Jr. of Fort Wayne - in closing arguments Thursday acknowledged their client had made an honest mistake, but insisted no evidence was presented to indicate being circumcised would prevent the youth from having a happy and productive life.

Ice said the impact on the infant was "short-lived, and there were no long-term effects."

Holding up a photo of the boy, Ice called him "healthy, happy (and) everything you could possibly want a kid to be."

Murphy scoffed at a suggestion by the lawyer for the boy and his mother - David Llewellyn, an Atlanta attorney who has made a specialty of [botched] circumcision-related litigation - that the boy should be compensated for suffering that would last a lifetime.

"Let's pay (the boy) $15 a day until he dies?" asked Murphy. "That's nonsense!"

Murphy said a ruling giving the boy $400,000 in damages would "open the courthouse door to every kid who's been circumcised." [YES!]

When Llewellyn interrupted Murphy's closing remarks, Judge John Feick warned the Georgia attorney that he would be found in contempt of court if he did it a second time.

Llewellyn told jurors that "this case is not about me, (and) it's not about a crusade."

"Full justice means full damages," he said, saying his client had "a right to be whole, a right to have a normal penis."

The attorney suggested the boy for the rest of his life would wonder, "What am I missing?"

Llewellyn called Burt a "kind and caring man," but said if the jury didn't award "full damages, then he's not taking responsibility."

The Atlanta lawyer compared the response by some to circumsion-related litigation to the ridicule that courtroom efforts on behalf of civil rights drew in the mid-20th century.

It's likely that this week's trial raised some issues never explored before in the Delaware County court system's 184-year history.

Testimony from experts on Wednesday focused in part on the relative sensitivity of the male sex organ, with one witness explaining [claiming, with no evidence] a penis could not be used, for instance, to read books published in Braille for the sight-impared.

WHO reforms long overdue, critics say

By Roger Collier

Budget and staff cuts are compelling the World Health Organization (WHO) to narrow its focus, a move that many observers of the organization say is long overdue.

The global experts also say that the WHO needs to essentially redefine and reposition itself within the increasingly complex and convoluted field of global health. The experts suggest that the world will not suffer if the WHO cuts certain programs while narrowing its focus. Many other health organizations have been created to address particular health concerns, such as HIV/AIDS, since the WHO formed in 1948.

...

For decades, the WHO has come under widespread criticism for having become an unwieldy, top-heavy, bureaucratic monstrosity that does many things poorly and few things well. Calls for reform have been frequent.

In 2002, the WHO was slagged as a "bureaucracy for bureaucracy's sake, mired in useless statement-making and conference-giving" (http://reason.com/archives/2002/01/01/who-cares). The harsh editorial argued that WHO had errantly shifted away from health into the realm of politics, taking on issues such as social inequality, and that the health concerns it did address were most pertinent to richer nations, such as increasing seat belt use, at the expense of the world's poor and sick. ...

In previous commentaries, WHO has been accused of suffering from such deficiencies as weak leadership and petty corruption (BMJ 1994;309:1424), and of being overstaffed and overcommitted (BMJ 1995;310:543-4).

[...making it ripe for capture by people with vested interests, such as circumcision.]

Even WHO's leaders are now pointing out shortcomings. In a recent report, WHO Director-General Dr. Margaret Chan wrote that the organization has done a poor job of strategically setting priorities, is duplicating work done by other health organizations and is too rigid to rapidly adapt to challenges (http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_4-en.pdf).

...

The WHO should also focus on solving the health problems of its member states, rather than focusing on the priorities of nations that are large donors, according to Dr. Martin McKee, professor of European public health at the London School of Hygiene & Tropical Medicine in the United Kingdom.

...

WHO's budgetary allocations are "heavily skewed toward infectious diseases" McKee and others have argued (Lancet 2008;372:1563-9). In 2006-07, WHO devoted 87% of its budget to combating infectious diseases, 12% to fighting noncommunicable diseases and 1% to injuries and violence. The analysis also found that often-earmarked funding from donor nations was "misaligned with the health needs of the main recipients of the WHO's activities."

Wrongful circumcision case begins

The mother of a boy circumcised against the family's wishes is seeking damages from a local doctor

MUNCIE -- A Muncie physician testified Tuesday that he would never have performed a circumcision on a newborn baby boy seven years ago if he thought the procedure caused lasting damage.

Physician Michael R. Burt was the first witness called to testify in a lawsuit filed against him by a local woman seeking damages because Burt circumcised her son against her wishes.

The mother also testified Tuesday, maintaining that while her now-7-year-old son is a happy, healthy child, "I believe (the circumcision) does affect him psychologically."

The lawsuit, filed in 2005 on behalf of the child, seeks damages from Burt, who admitted in court Tuesday that he made a mistake in performing the circumcision. The boy and his mother have already reached an out-of-court settlement with IU Health Ball Memorial Hospital, where the boy's birth and circumcision took place.

No testimony during Tuesday's hearing reflected that the circumcision was performed in a deficient manner. The lawsuit is based solely on the damages resulting from Burt performing the circumcision in spite of a consent form that the mother had crossed out with a large "X."

The day began with opening arguments that included slides and information so detailed that Ed Murphy, one of Burt's attorneys, told jurors they had "been presented with an anatomy lesson."

During his opening argument, the mother's attorney, David Llewellyn, an Atlanta-based specialist in circumcision-related litigation, led the jury through a series of slides that detailed how the medical procedure is performed.

Llewellyn criticized - in advance - one witness likely to be called by Burt's attorneys, noting that the expert had written a poem, "Ode to the Circumcised Male."

[In the event, Edgar Schoen was not called.]

Murphy maintained that the "vast majority" of local males are circumcised, meaning that the boy -- once he is old enough to share a locker room with teammates in school sports -- "will look around and see other boys are exactly like he is."

During his testimony, Burt said, "If I believed circumcision caused damage, I would never do it."

Objections from attorneys on both sides came frequently during Tuesday's testimony, with Delaware Circuit Court 4 Judge John Feick conducting sessions outside the presence of the six-member jury, including one discussion of whether the mother should be able to testify about questions her son posed to her.

The woman said her son had, on more than one occasion, asked why he looked different than his older brother, who is not circumcised.

Testimony is expected to continue today with a series of expert witnesses representing both the boy and the physician.

California prevents ban on male circumcision

(Reuters) - California Governor Jerry Brown announced on Sunday that he signed a bill preventing local authorities from banning the practice of male circumcision.

The bill, which takes effect immediately, comes in the wake of an effort by a San Francisco group opposed to male circumcision to enforce a city-wide ban of the practice in a November ballot measure.

That effort was struck down in late July by a California judge who said it would infringe on religious freedom. The measure was removed from the November ballot.

The measure, which garnered 12,000 signatures of support, would have made it a misdemeanor crime to circumcise a boy before he is 18 years old in San Francisco, regardless of the parents' religious beliefs.

A dozen petitioners sued to block the initiative at the time. A similar effort in Santa Monica, west of Los Angeles, was withdrawn.

Circumcision is a ritual obligation for infant Jewish boys [no, their parents] and also a common rite among Muslims, who account for the largest share of circumcised men worldwide.

The move to outlaw circumcision in San Francisco raised alarm bells for Jewish groups.

In June, the Anti-Defamation League condemned a comic book created by supporters of the anti-circumcision movement that it said contained grotesque anti-Semitic imagery. The comic featured a character named "Monster Mohel" as an evil villain.

A mohel is a Jewish individual specifically trained to perform the ritual circumcision of infant boys.